Underdiagnosis of Depression in Patients with Coronary Artery Disease: The Role of Nonspecific Symptoms

Freedland, Kenneth E.; Lustman, Patrick J.; Carney, Robert M.; Hong, Barry A.

doi:10.2190/yf10-h39r-ny6m-mt1g

Cited by 81 publications

(46 citation statements)

References 17 publications

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“…In a similar vein, elimination of sleep and appetite disturbance from the diagnostic criteria was found to increase the prognostic impact of depression for patients with new MI in another study (Lesperance et al, 1996). It is important to remember that cardiac patients who are not depressed often report fatigue and sleep disturbance, particularly in the days immediately following an acute cardiac event (Freedland, Lustman, Carney, & Hong, 1992). Therefore, it may be the case that for this group; since these somatic symptoms are not specific to depression, the affective and cognitive elements of depression rise to the fore in prognostic impact.…”

Section: Themes In Depression With Chdmentioning

confidence: 84%

Depression in chronic medical illness: The case of coronary heart disease

2001

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Depression is an important predictor of morbidity and mortality in patients with coronary disease, particularly after myocardial infarction, independent of previous cardiac history or CAD severity. Depression also is associated with poor long-term psychosocial outcomes. The prevalence of major depression among post-MI patients is 15 to 20%, with an additional 27% reporting symptoms of minor depression. This article briefly reviews the literature on depression in patients with coronary disease, including previously published efforts to treat the disorder in this group. A case review then is provided, highlighting important aspects of treatment.

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Section: Themes In Depression With Chdmentioning

confidence: 84%

Depression in chronic medical illness: The case of coronary heart disease

2001

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“…Only two studies were conducted with cancer patients [10,37]. Other studies included patients with neurologic [7,20,21] and cardiovascular diseases [22]. One study investigated chronic pain patients [51].…”

Section: Introductionmentioning

confidence: 99%

“…Another five studies were conducted with heterogeneous samples of medical patients [14,26,32,35,49]. Fewer than half of the studies (none with cancer patients) assessed symptomatology with (semi-) structured clinical interviews based on categorical diagnostics [22,26,32,35,49,51]. In all other studies, dimensional self-report questionnaires, mainly the Beck Depression Inventory or the Hamilton Rating Scale for Depression, were used.…”

Section: Introductionmentioning

confidence: 99%

Depressive symptom patterns and their consequences for diagnosis of affective disorders in cancer patients

Reuter

Raugust

Bengel

et al. 2004

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“…The early morning awakenings and diurnal mood variations indicate altered biological rhythms (Healy & Williams 1988, Syvälahti 1994). Patients with CAD had more severe insomnia than non-depressed patients with CAD, whereas insomnia and fatigue were the most frequent somatic complaints (Freedland et al 1992).…”

Section: 3 Psychological Symptomsmentioning

confidence: 90%

Sleep, psychological symptoms and quality of life in patients undergoing coronary artery bypass grafting

Edéll-Gustafsson

1999

Nordic Journal of Psychiatry

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In this thesis sleep, psychological symptoms and quality of life (Qol) in patients undergoing coronary artery bypass grafting (CABG) at the University Hospital in Linköping were evaluated. Interviews and 24-hour polysomnography were performed prior to surgery, immediately after surgery and again at one month, with a six-monthfollow-up mailed questionnaire. Habitual sleep was evaluated using the Uppsala Sleep Inventory questionnaire and a diary the recorded mornings. The Spielberger State of Anxiety Scale and the Zung´s Self-rating Depression Scale were used to measure anxiety and depression, respectively. Physical functional capacity was assessed according to the New York Heart Association´s (NYHA) classes and Qol, with the Nottingham Health Profile instrument (NHP).A retrospective evaluation of nurse's documentation about sleep was also performed. In addition, the quality and quantity of sleep were assessed before surgery and in the immediate postoperative period in a pilot study, with a one-month follow-up interview. The results indicated disturbed sleep, and changes in behaviour and mental state after surgery due to fragmented sleep, pain and anxiety.Forty-four patients were examined prior to surgery. The results showed that almost two-fifths experienced too little sleep habitually and 50 % had a combination of at least two sleep problems. Poorer health, higher level of anxiety and increased difficulties maintaining sleep (DMS) were consistent with significantly longer sleep latency, increased fragmented sleep, and reduced stages 3 and 4 and REM sleep measured by polysomnography. The level of Qol on the NHP was significantly associated with objectively measured sleep.In the immediate period following CABG there is a changed distribution of sleep, with a reduction of nocturnal sleep duration and an increase in daytime sleep, which had almost returned to preoperative values one month after surgery. Qol was significantly improved six months after surgery compared to before surgery.It was noted that patients with a more anxiety prone reactivity during six months following CABG had significantly more sleep disturbances, reduced energy and functional physical capacity, and lower quality of life, compared to those without such reactivity. Significantly more sleep disturbances, reduced energy and lower quality of life were more prominent among those with sadness/depression or cognitive/behavioural fatigue as reactions to sleep loss. A higher degree of cognitive/behavioural fatigue and dysphoria reactions were associated with a higher NYHA class.In conclusion, patients with coronary artery disease have poor quantity and quality of sleep. Increased psychological symptoms in patients with CAD prior to surgery were associated with greater symptoms six months after surgery. Physical functional capacity and quality of life were significantly improved six months after surgery

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Underdiagnosis of Depression in Patients with Coronary Artery Disease: The Role of Nonspecific Symptoms

Abstract: The symptoms of major depression were found to be relatively mild and nonspecific in patients with CAD. This may help to explain why depression is underdiagnosed in cardiac patients.

Cited by 81 publications

References 17 publications

Depression in chronic medical illness: The case of coronary heart disease

Depression in chronic medical illness: The case of coronary heart disease

Depressive symptom patterns and their consequences for diagnosis of affective disorders in cancer patients

Sleep, psychological symptoms and quality of life in patients undergoing coronary artery bypass grafting

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