Vol. 141 No. 2930 (2011)
Prevalence and predictors of depressive symptoms and wellbeing during and up to nine years after outpatient cardiac rehabilitation
BACKGROUND AND AIM: Depression is an important independent prognostic variable in cardiac patients. The prevalence and predictors of depressive symptoms up to nine years after cardiac rehabilitation were studied.
METHODS:Follow-up questionnaires were sent to 2199 patients who had completed a 12-week exercise-based outpatient cardiac rehabilitation (OCR) programme between June 1999 and March 2006. Medical outcome, general wellbeing, and depressive symptoms were assessed, the latter by using two screening questions according to Arrol. Patients with incomplete data due to language problems, lack of compliance and non-response were excluded.
RESULTS:Complete data for analysis was available for 710 patients. The median follow up period was 46 months (Interquartile range (IQR) 22-71, min. 6 months). At follow-up, 132 patients (19%) indicated low wellbeing, whereas 81 (11%) were having depressive symptoms.
Multivariate analyses revealed impaired quality of life (p <0.001), diabetes (p = 0.013) and low exercise capacity after OCR (p = 0.003) to be independent predictors of low wellbeing at follow-up. Persistent smoking (p = 0.045) as well as negative mood (p = 0.022) at the end of OCR were independent predictors of depressive symptoms at follow-up.
CONCLUSIONS: In a selected patient population a mean of four years after OCR, persistent smoking, diabetes, low exercise capacity and impaired quality of life at the end of OCR were independent long term predictors of low wellbeing and depressive symptoms, rather than specific cardiac variables. This highlights the need for close cooperation between cardiovascular and psychological specialists in cardiac rehabilitation.
- Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction: impact on 6-month survival. JAMA. 1993;270:1819–25.
- Forrester AW, Lipsey JR, Teitelbaum ML, De Paulo JR, Andrzejewski PL. Depression following myocardial infarction. Int J Psychiatrie Med. 1992;22:33–46.
- Binder RK, Barth J, Schmid JP, Saner H. Burden of abdominal obesity in cardiac rehabilitation patients. Swiss Med Wkly. 2011;141:w13153
- Kemo DE, Malhotra S, Franco KN, Tesar G, Bronson DL. Heart disease and depression: dont ignore the relationship. Cleve Clin J Med. 2003;70:745–6, 749–50, 752–4 passim.
- Bush DE, Ziegelstein RC, Tayback M, et al. Even minimal symptoms of depression increase mortality risk after acute myokardial infarction. Am J Cardiol. 2001;88:337–41.
- Zellweger MJ. Coronary artery disease and depression. Eur Heart J. 2004;25:3–9.
- Swaab DF, Bao AM, Lucassen PJ. The stress system in the human brain in depression and neurodegeneration. Ageing Res Rev. 2005;4:141–94.
- Boudarene M, Legros JJ, Timsit-Berthier M. Study of the stress response: role of anxiety, cortisol and DHEAs. Encephale. 2002;28:139–46.
- Meaney MJ, Dioro J, Francis D, Widdowson J, LaPlante P, Caldji C, et al. Early environmental regulation of forebrain glucocorticoid receptor gene expression: implications for adrenocortical responses to stress. Dev Neurosci. 1996;18:49–72.
- Lynch D, Tamburino M, Nagel R. Depressive Symptoms: associations with health perceptions and health behaviors. Department of Family Medicine, Medical College of Ohio, Toledo, USA 1996;4:68–72.
- Rozanski A, Blumenthal JA, Kaplan J. Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy. Circulation.1999;99:2192–217.
- Pfiffner D, Hoffmann A. Psychosocial Predictors of Death for Low-Risk Patients After a First Myocardial Infarction: A 7-year follow-up study. J Cardiopulm Rehabil. 2004;24:87–93.
- Smith OR, Pedersen SS, Van Domburg RT, Denollet J. Symptoms of fatigue and depression in ischemic heart disease are driven by personality characteristics rather than disease stage: a comparison of CAD and CHF patients. Eur J Cardiovasc Prev Rehabil. 2008;15:583–8.
- Jeger RV, Jörg L, Rickenbacher P, Pfisterer ME, Hoffmann A. Benefit of outpatient cardiac rehabilitation in underpresented patient subgroups. J Rehabil Med. 2007;39:246–51.
- Siegrist J, Broer M, Junge A. Profil der Lebensqualität Chronisch kranker (PLC). Göttingen: Hogrefe Verlag; 1996.
- Laubach W, Schröder C, Siegrist J, Brähler E. Normierung der Skalen «Profil der Lebensqualität Chronisch Kranker» an einer repräsentativen deutschen Stichprobe. Zeitschrift für Differentielle und Diagnostische Psychologie 2001;104:2996–3007.
- Arrol B, Khin N, Kerse N, Auckland, New Zealand. Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ. 2003;327:1144–6.
- Birkel-Smith M, Hansen BH, Hanash JA, Hansen JF, Rasmussen A. Mental disorders and general well-being in cardiology outpatients – 6-year survival. J Psychosom Res. 2009;67:5–10. Epub 2009 Mar 5.
- Angst J. The epidemiology of depressive disorders. Europ Neuropsychopharmacology 1995;Suppl 95–8.
- Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depession, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370:851–8.
- Batra A, Collins SE, Torchalla I, Schröter M, Buchkremer G. Multidimensional smoker profiles and their prediction of smoking following a pharmacobehavioral intervention. J Subst Abuse Treat. 2008;35(1):41–52 Epub 2007 Oct.10
- Vieyra-Reyes P, Venebra-MunozA, Rivas-Santiago B, Garcia-Garcia F. Nicotine as an antidepressant and regulator of sleep in subjects with depression. Rev Neurol. 2009;49:661–7.
- Salin-Pascual RJ, Rosas M, Jimenz-Genchi A, Rivera-Meza BL, Delgado-Parra V. Antidepressant effect of transdermal nicotine patches in nonsmoking patients with major depression. J Clin Psychiatry. 1996;57:387–9.
- Mineur YS, Picciotto M. Biological basis for the co-morbidity between smoking and mood disorder. J Dual Diagn. 2009;122–30.
- Hirsch RD, Junglas K, Kontadt B, Jonnitz MF. Humor therapy in the depressed elderly: Results of an empirical study. Z Gerontol Geriatr. 2010;43:42–52.
- Trivedi MH, Pigotti TA, Perera P Dillingham KE, Carfagno ML, Pitts CD. Effectiveness of low doses of paroxetine controlled release in the treatment of major depression disorder. J Clin Psychiatry. 2004;65:1356–64.
- Fournier JC, DeRubeis, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, et al. Antidepressant drug effects and depression severity: a patient level meta-analysis. JAMA. 2010,6;303:47–53.
- Scott J. Cognitive therapy of affektive disorder: a review. J Affect Disord. 1996;12;37:1–11.
- Coxtall JD, Scott LJ. Olanzapine/ Fluoxetine: a review of its use in patients with treatment-resistant major depressive disorder. CNS Drugs. 2010 1;24:245–62. doi:10.2165/112038-000000000-00000
- DeRubeis RJ, Siegle GJ, Hollon SD. Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nat Rev Neurosci. 2008;9:788-96. Epub 2008 Sep 11.