Depression of Chronic Medical Inpatients in China

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Odds of major depression have significantly increased among adults with chronic diseases. However, the diagnosis of depression is often unrecognized in China. To know the prevalence of depression in medical inpatients with different chronic diseases and to assess the level of unrecognized depression among hospitalized patients, we assessed depression in patients with cardiovascular disease, diabetes, and chronic pulmonary heart disease. In this study, it has been shown that 78.9% of patients with pulmonary heart disease, diabetes, hypertension, or coronary heart disease have different levels of depression. There were no significant differences in incidence of depression among different gender, age, education levels, marital status, or course of disease. There were no significant differences in total incidence rate of depression and in incidence rate of different levels of depression among the three groups of patients. It is very important to help patients with chronic diseases to reduce their depression by psychological nursing after evaluating their mental status.

Section snippets

Background

Chronic illness is defined, in keeping with the U.S. National Center for Health Statistics definition, as any illness of 3 or more months' duration (Stedman, 1995). It was the leading cause of death in the world in 2002 (Yach et al., 2004). In China, more than 160 million people are chronically ill patients (MHPRC, 2004). The morbidity rate of hypertension was 18.8% among adults and became the number one cause of death; diabetes, on the other hand, will pose a great threat to the Chinese people

Design and methods

This study was designed as a cross-sectional study (Sun, 2005). We used a sampling procedure involving four steps. First, we selected Changsha (a city the in Hunan Province of China) as the study site, a moderate city in respect to its local economic, demographic, and geographical features. Second, we identified four top hospitals by convenient sampling. Third, we chose all of the cardiovascular, respiratory, and endocrine medical wards in these hospitals by means of cluster sampling. Finally,

General Data

Three hundred twenty-two patients were divided into three groups according to the disease category: pulmonary heart disease (29.8%, n = 96), diabetes (38.5%, n = 124), and hypertension and coronary atherosclerotic heart disease (31.6%, n = 102). Of the 322 patients, 184 (58.4%) were men and 138 (41.6%) were women. The median age for all participants is 60.32 years, with a range of 18 to 90. Most (85.09%, n = 274) of the patients were married. Most respondents (78.26%, n = 252) have completed at

Depression and Chronic Diseases

Of patients with pulmonary heart disease, diabetes, hypertension or coronary heart disease, 78.9% had varying degrees of depression, which confirms that chronic disease seriously affects the mental health of patients. The incidence of major depression significantly increased among patients with pulmonary heart disease, diabetes, hypertension, or coronary heart disease. This finding is parallel with those of Anderson et al., 2001, Egede, 2005, Scherrer et al., 2003, Shi et al., 2000, Zhang et

Implications for health care

Person-centered nursing is regarded as the optimum way of delivering health care and is defined as valuing people as individuals. Early proponents of person centeredness theories began to recognize the importance of ethical and legal rights of people and the importance of holistic care in maintaining well-being. McCormack (2003) found that nurses need to acknowledge the singularity of their patients and identify their specific needs, establish a health care professional–patient relation, and

Study limitations

There were several limitations to this study. First, there may be sampling bias because the results were obtained from only four institutions, which are all teaching hospitals and ranked as first-class hospitals in Hunan. Inpatients were numerous, and the categories of diseases were comprehensive; thus, it was easier to carry out this survey. Second, the intensity and acuity of the chronic condition were higher. Therefore, depression in patients in our study was greater than the depression of

Conclusions

Most of the patients (78.9%) with cardiovascular disease, diabetes, and chronic pulmonary heart disease screened positive for depression in Changsha. The prevalence of diagnosed depression, however, is low because of hegemonic influence of the medical model. Both medical professionals and patients focused their attention primarily on the chronic illness and on preventing or minimizing associated limitations. This contravened the philosophy of person-centered nursing, which emphasizes the

Acknowledgment

This study was supported by the Health Department of Hunan Province (series ZD02-01) and the Nursing School of the Central South University in China. We are grateful to all the participants. We also thank Dr. Shuqiao Yao for his suggestions, and we acknowledge the resources and support available from the Psychological Research Center in the second teaching hospital of the Central South University.

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