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From the Department of Psychiatry (K.E.F., J.A.S, R.M.C.), Cardiovascular Imaging and Clinical Research Core Laboratory (V.G.D.-R.), and Cardiovascular Division, Department of Medicine (M.W.R, V.G.D.-R.), Washington University School of Medicine, St. Louis, Missouri; and the Cardiovascular Division, Department of Medicine (A.S.J.), Mayo Clinic, Rochester, Minnesota.
Address reprint requests to: Kenneth E. Freedland, PhD, Department of Psychiatry, Washington University School of Medicine, 4625 Lindell Blvd., Suite 420, St. Louis, MO 63124. Email: freedlak{at}bmc.wust.edu
OBJECTIVE: Prevalence estimates of depression in hospitalized patients with congestive heart failure (CHF) differ considerably across studies. This article reports the prevalence of depression in a larger sample of hospitalized patients with CHF and identifies demographic, medical, psychosocial, and methodological factors that may affect prevalence estimates.
METHODS: A modified version of the Diagnostic Interview Schedule was administered to a series of 682 hospitalized patients with CHF to determine the prevalence of DSM-IV major and minor depression; 613 patients also completed the Beck Depression Inventory. Medical, demographic, and social data were obtained from hospital chart review, echocardiography, and patient interview.
RESULTS: In the sample as a whole, 20% of the patients met the DSM-IV criteria for a current major depressive episode, 16% for a minor depressive episode, and 51% scored above the cutoff for depression on the Beck Depression Inventory (
10). However, the prevalence of major depression differed significantly between strata defined by the functional severity of heart failure, age, gender, employment status, dependence in activities of daily living, and past history of major depression. For example, the prevalence ranged from as low as 8% among patients in New York Heart Association class I failure to as high as 40% among patients in class IV.
CONCLUSIONS: The prevalence of depression in hospitalized patients with CHF is similar to rates found in post-myocardial infarction patients. However, it is considerably higher in certain subgroups, such as patients with class III or IV heart failure. Further research is needed on the prognostic importance and treatment of comorbid depression in CHF.
Key Words: comorbidity • depression • depressive disorder • heart failure • congestive • prevalence.
Abbreviations: ADLs = activities of daily living; BDI = Beck Depression Inventory; CES-D = Center for Epidemiological Studies Depression Scale; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; DIS = Diagnostic Interview Schedule; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition; HRDS = Hamilton Rating Scale for Depression; LVEF = left ventricular ejection fraction; MI = myocardial infarction; NYHA = New York Heart Association.
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