Up-Beat UK: A programme of research into the relationship between coronary heart disease and depression in primary care patients

Abstract

BackgroundCoronary heart disease and depression are both common health problems and by 2020 will be the two leading causes of disability worldwide. Depression has been found to be more common in patients with coronary heart disease but the nature of this relationship is uncertain. In the United Kingdom general practitioners are now being remunerated for case-finding for depression in patients with coronary heart disease, however it is unclear how general practitioners should manage these patients. We aim to explore the relationship between coronary heart disease and depression in a primary care population and to develop an intervention for patients with coronary heart disease and depression.Methods/designThis programme of research will consist of 4 inter-related studies. A 4 year prospective cohort study of primary care patients with coronary heart disease will be conducted to explore the relationship between coronary heart disease and depression. Within this, a nested case-control biological study will investigate genetic and blood-biomarkers as predictors of depression in this sample. Two qualitative studies, one of patients' perspectives of treatments for coronary heart disease and co-morbid depression and one of primary care professionals' views on the management of patients with coronary heart disease and depression will inform the development of an intervention for this patient group. A feasibility study for a randomised controlled trial will then be conducted.DiscussionThis study will provide information on the relationship between coronary heart disease and depression that will allow health services to determine the efficiency of case-finding for depression in this patient group. The results of the cohort study will also provide information on risk factors for depression. The study will provide evidence on the efficacy and feasibility of a joint patient and professional led intervention and data necessary to plan a definitive randomised controlled trial of the intervention.

Psychosocial Wellbeing of Patients Diagnosed with Coronary Artery Disease

“…Recent studies identified depression and psychological distress as a significant risk factor among patients diagnosed with CHD, which play remarkable role in the development and prognosis of disease (Stafford et al, 2009;Jiang et al, 2002;Chandola et al, 2007;Albus, 2010;Tylee et al, 2011). However, patients from this study had mild depressive symptom and moderate level of psychological distress, which contradict with previous reports.…”

“…Studies reported that depression and stress evoke central responses by enhancing the activity of central nervous system and hypothalamic pituitary track which leads to central obesity, insulin resistant, inflammation process, hypertension, platelet activation, and endocrine dysfunction leading to development of CHD (Albus, 2010;Charlson et al, 2011). Moreover, stress and depression were also linked to negative health related behaviors such as low physical activity, poor diet, smoking, and a lack of interest that are also anticipate precursor for CHD (Chandola et al, 2008;Tylee et al, 2011). The literature has also emphasized the role of social factors such as social support and family life and coping in predicting CHD (Albus, 2010).…”

Using a patient-generated mental-health measure ‘PSYCHLOPS’ to explore problems in patients with coronary heart disease

“…15 A total of 15 general practices in south London were recruited to the study with a registered population of 150 973 people. Of these, 3325 (2.2%) were on the CHD register, about half of whom had experienced an MI; the remainder had been diagnosed with ischaemic heart disease, usually on the basis of angina.…”

“…severity of depressive symptoms in patients with symptomatic CHD. 15 Comparator instruments consisted of three measures of psychological status:…”

“…This study was part of UPBEAT-UK, a larger programme of research into the relationship between CHD and depression in primary care, and the evaluation of an intervention. 15 Based on previous qualitative research findings, the study hypothesised that patients with CHD with continuing cardiac symptoms may differ in their psychometric characteristics when compared with patients reporting other problems. 8,10 This study aimed to use PSYCHLOPS in a primary care cohort of patients with CHD in order to define categories of patient concern.…”