Clinical Investigations: Acute Ischemic Heart Disease
Association between depression and worse disease-specific functional status in outpatients with coronary artery disease,☆☆

https://doi.org/10.1067/mhj.2000.106600Get rights and content

Abstract

Background The objective of this study was to determine if depression is associated with worse disease-specific functional status in patients with coronary artery disease. The study was designed as a cross-sectional survey and 3-month longitudinal cohort. Methods and Results The study took place in outpatient clinics of 3 Veterans Administration hospitals. All 7282 enrollees were surveyed and 4560 (62.6%) returned baseline questionnaires, including a screening instrument for depression. Thirty-nine percent (n = 1793) reported evidence of coronary artery disease and 1282 patients (71.5%) returned the Seattle Angina Questionnaire; 1025 patients (80%) completed a subsequent 3-month series of instruments. Main outcome measures used were the Seattle Angina Questionnaire, a valid, reliable, and responsive disease-specific functional status measure for patients with coronary disease, and the Mental Health Inventory, a mental health screening instrument from the Short Form-36. Mental Health Inventory evidence of depression was associated with significantly worse disease-specific functional status. Depressed patients had more physical limitation (mean difference in Seattle Angina Questionnaire score = 16.9, P <.001), more frequent angina (mean difference in Seattle Angina Questionnaire score = 9.5, P <.001), less satisfaction with their treatment for coronary artery disease (mean difference in Seattle Angina Questionnaire score = 9.9, P <.001), and lower perceived quality of life (mean difference in Seattle Angina Questionnaire score = 16.3, P <.001) than nondepressed patients. Frequency of depressive symptoms demonstrated an inverse relation with cardiac-specific functional status and when patients’ depression status changed over time, so did their cardiac-specific health status. Conclusions Depression is associated with significantly more physical limitation, more frequent angina, less treatment satisfaction, and lower perceived quality of life in outpatients with coronary artery disease. (Am Heart J 2000;140:105-10.)

Section snippets

Patient selection and study design

All patients enrolled in the general internal medicine clinics of 3 Veterans Administration medical centers on December 1, 1993, were included in this study. All patients were mailed a questionnaire packet that included a medical history questionnaire and the Mental Health Inventory. Respondents who reported a history of a coronary event, revascularization procedure, or who described a history of angina pectoris were identified as having coronary artery disease and were sent the Seattle Angina

Patient response

Of 7282 patients enrolled in one of the three General Internal Medicine Clinics, 4560 (62.6%) patients returned the baseline questionnaires. Respondents were older than nonrespondents (65.6 vs 62.6 years, P <.01) and hospitalized less often over the preceding year (mean number of hospitalizations 0.40 vs 0.47, P <.01). There was no significant difference in sex (96.5% vs 97.1% men) or the mean number of clinic visits during the preceding year (mean = 4.5 for both groups).

Among the respondents,

Discussion

Other investigators have demonstrated a relation between depression and general health–related quality of life among patients with coronary artery disease17 or the presence of angina (coded as present or not) 6 months after myocardial infarction.18 To our knowledge, this is the first study to demonstrate the strong relation between a positive screen for depression in outpatients with stable coronary disease and cardiac-specific symptoms, limitations, and functional status. Three characteristics

Acknowledgements

We thank Mark Sullivan, MD, PhD, for critique and constructive review of this article.

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    Supported by the Department of Veterans Affairs, Cooperative Studies in Health Services Research (CSHS #91-007). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veteran Affairs.

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    Reprint requests: John Spertus, MD, MPH, Saint Luke’s Hospital of Kansas City, 4401 Wornall Rd, Kansas City, MO 64111.E-mail:[email protected].

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