Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study

Abstract

BackgroundDepressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD.MethodsBased on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways. We screened for univariable association with response, using either analysis of (co)variance or logistic regression, respectively, both adjusted for baseline HADS-D value and treatment group. To guard against overfitting, multivariable association was evaluated by a linear or binomial (generalised) linear model with lasso regularisation, a machine learning approach. Outcome measures were the change in continuous HADS-D depression scores, as well as three established binary criteria. The Charlson Comorbidity Index (CCI) was calculated to assess possible influences of comorbidities on our results and was also entered in our machine learning approach.ResultsHigher age (p = 0.002), unknown previous myocardial infarction (p = 0.013), and a higher heart rate variability during numeracy tests (p = .020) were univariably associated with a favourable depression outcome, whereas hyperuricemia (p ≤ 0.003), higher triglycerides (p = 0.014), NYHA class III (p ≤ 0.028), state after resuscitation (p ≤ 0.042), intake of thyroid hormones (p = 0.007), antidiabetic drugs (p = 0.015), analgesic drugs (p = 0.027), beta blockers (p = 0.035), uric acid drugs (p ≤ 0.039), and anticholinergic drugs (p = 0.045) were associated with an adverse effect on the HADS-D depression score. In all analyses, no significant differences between study arms could be found and physical comorbidities also had no significant influence on our results.ConclusionOur findings may contribute to identification of somatic and sociodemographic predictors of depression outcome in patients with CAD. The unexpected effects of specific medication require further clarification and further research is needed to establish a causal association between depression outcome and our predictors.Trial registrationwww.clinicaltrials.gov NCT00705965 (registered 27th of June, 2008).www.isrctn.com ISRCTN76240576 (registered 27th of March, 2008).Electronic supplementary materialThe online version of this article (10.1186/s12888-019-2026-6) contains supplementary material, which is available to authorized users.

Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics?

“…A finding of note was that having a higher total number of comorbidities was a significant determinant of depressive symptoms. A prior study employing RCT data in their analysis was unable to find an association between comorbidities and depressive symptoms, 28 which perhaps could be explained by the younger population (mean age 59.1±19.8) compared with the current study (66.24±10.69). Indeed, a recent meta-analysis of CR trials recommends future trials involve patients who are more representative of the broader patients with CVD, including patients with comorbidities.…”

To what extent is multi-morbidity associated with new onset depression in patients attending cardiac rehabilitation?

“…In addition, a range of comorbidities including angina, arthritis, diabetes, rheumatism, stroke, osteoporosis, chronic bronchitis, emphysema, asthma, anxiety, claudication, and chronic back problems were found to be more prevalent in patients with new onset depressive symptoms. However, a prior RCT data driven study of Vitinius et al [24] was not able to find an association between comorbidities and depressive symptoms. This may be due to their population being younger (mean age 59.1 ± 19.8) in comparison to ours (65.79 ± 11.14).…”

Effects of comprehensive nursing intervention based on self-disclosure on improving alexithymia in elder patients with coronary heart disease

“…The Toronto Alexithymia Scale-20 items (TAS-20) was used to assess alexithymia of CHD patients, which has a threefactor structure based on the subscales differential item functioning (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT) [15]. The Hospital Anxiety and Depression Scale (HADS) was used to calculate symptoms of depression (HADS-D) and anxiety (HADS-A) [16]. Sleep quality, sleep score and sleep duration was recorded during experiments in all CHD patients as described previously [17].…”