European Heart Journal Advance Access originally published online on February 15, 2006
European Heart Journal 2006 27(9):1123; doi:10.1093/eurheartj/ehi798
Psychological distress and cardiovascular disease
Department of Cardiology
University Medical Center Groningen
University of Groningen
PO Box 30001
9700 RB Groningen
The Netherlands
Tel: +31 50 3614889
E-mail address: g.a.t.lesman-leegte{at}thorax.umcg.nl
Department of Cardiology
University Medical Center Groningen
University of Groningen
PO Box 30001
9700 RB Groningen
The Netherlands
Department of Cardiology
University Medical Center Groningen
University of Groningen
PO Box 30001
9700 RB Groningen
The Netherlands
With interest, we read the article by Ferketich and Binkley1 in which they examined psychological distress; depressive symptoms, and anxiety are among individuals with heart disease. Psychological distress was measured with an uncomplicated six-item questionnaire that was developed for this study. The results showed that the greatest proportion of psychological distress (10%) was estimated among participants with self-reported chronic heart failure (CHF). Self-reported CHF was associated with three-fold increased odds of having psychological distress. The authors also state that perhaps most alarming is the very low number of patients who saw a mental health professional within the past year, which was only 35%, even in those heart failure (HF) patients with psychological distress.
We feel that these data are important as they support earlier data2 that have shown that this problem is underestimated and undertreated in HF patients. We would like to confirm and elaborate on this finding. We recently completed baseline data of 1050 elderly hospitalized patients with a confirmed diagnosis of HF.3 Mean age of the sample was 72 years and 40% was female. When compared with Ferketich and Binkley,1 we used a more extensive tool to measure depressive symptoms in CHF patients: the Center for Epidemiological Studies Depression Scale (CES-D).3,4 A cut-off value of 16 was used to define patients at risk for clinical depression. Almost 40% of the participants reported depressive symptoms. Not more than 8% of these 388 HF patients with depressive symptoms had anti-depressive medication described at discharge from the hospital.
In his editorial, Belardinelli5 recommends that clinicians make screening for psychological distress a routine evaluation of the patient with cardiovascular disease. The screening should be used as a means to alert the clinician that the patient may have need for psychological care and serve as a basis for referral to mental health professionals. We agree with Belardinelli and Ferketich to adjust more attention to psychosocial problems and find appropriate strategies to help patients deal with distress after cardiac disease.6
References
- Ferketich AK, Binkley PF. Psychological distress and cardiovascular disease: results from the 2002 National Health Interview Survey. Eur Heart J 2005; 26: 1923–1929.
[Abstract/Free Full Text] - Jacob S, Sebastian JC, Abraham G. Depression and congestive heart failure: are antidepressants underutilized? Eur J Heart Fail 2003; 5: 399–400.
[Free Full Text] - Jaarsma T, Van Der Wal MH, Hogenhuis J, Lesman I, Luttik ML, Veeger NJ, Van Veldhuisen DJ. Design and methodology of the COACH study: a multicenter randomised Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. Eur J Heart Fail 2004; 6: 227–233.
[Abstract/Free Full Text] - Ensel WM. Measuring depression: the CES-D scale. In: Lin N, Dean A, Ensel WM, eds. Social Support, Life Events and Depression. Orlando: Academic Press Inc.; 1986. p50–71.
- Belardinelli R. The whole is greater than its parts. Eur Heart J 2005; 26: 1820–1821.
[Free Full Text] - Van Der Wal MH, Jaarsma T, van Voorst R. Psychiatric nurse; member of the HF management team? Eur J Cardiovasc Nurs 2005; 4: 99–100.[CrossRef][Medline]
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