Even Mild Depression Shortens Your
Life
Science Blog
March 9, 2005
Emotional
health may play a far greater role in the long-term survival of
patients suffering from chronic heart failure, according to a
new study that compared the mortality rates of patients based on a
common screening test for depression. So much so, even patients
considered to be in a sub-depressive state are at increased risk of
death.
Wei Jiang,
M.D., presented results of the seven year study at the annual
scientific sessions of the American College of Cardiology in Orlando,
in March 2005.
The
research team followed 1,005 heart failure patients admitted to Duke
University Hospital for various cardiac events. During their
hospitalization, patients were given the Beck's Depression Inventory
(BDI), a commonly used depression screening test. Patients were
followed for seven years to determine the ability of BDI scores to
predict death.
Jiang et al
found
a strong association between depression and a higher
long-term risk of death for patients with chronic heart failure.
A psychological status previously considered to be sub-depressive
puts these patients at higher risk of death.
"Approximately half of all patients with heart failure will die
within five years of diagnosis."
In general,
patients with a BDI score of 10 are considered mildly depressed,
while patients with scores of 12 to 19 can be considered mild to
moderately depressed. Jiang said that the traditional cutoff value
of BDI for assessing the prognostic predictability was a score of
10.
"…the
greatest risk occurred when we lowered the threshold …
patients scoring 7 or higher had a 51 percent higher risk of dying.
… This adverse association of depression and increased long-term
mortality was independent of other factors, including age, marriage,
cardiac function and the root cause of the heart failure,"
Jiang said.
Jiang said
that many cardiologists or primary care physicians who treat heart
failure patients may be unfamiliar with, or too busy to include, a
psychological assessment into their practice. However, tests like
the BDI do not require special training and can be completed in 10
minutes.
The
mechanisms behind the correlation are not well understood. However,
depressed patients have altered blood platelet aggregation
properties, elevated immune-inflammatory responses and a decrease in
the heart's ability to react appropriately to the stresses of
everyday life.
"We also know
that depressed patients tend not to comply with their treatments,
are not as motivated to stick with exercise or rehabilitation
programs, and often miss doctor's appointments" Jiang said. "Also,
depressed patients tend to make unhealthy life-style choices in such
areas as diet and smoking."
While
anxiety is often present with depression, depression appears to be
the main risk factor for the patients in this study. In the Nov. 30
issue of the journal Circulation, Jiang noted that while anxiety and
depression are highly correlated in heart failure patients,
depression alone predicts a significantly worse prognosis after one
year.
Stephanie
Thompson's comments:
Very interesting
news. Prior to this the strongest known correlation with heart
deaths was with measures of hostility. Mild depression
sounds so much more innocuous - but clearly, from this evidence, it
is not.
However, I’m not
wholey convinced that depression causes heart disease per
se. Yes, it correlates, but that’s not the same thing. It’s
hard not to notice how many of the lifestyle factors which result in
heart problems quite independently cause the nervous system to
malfunction, resulting in depression, hostility, anxiety and similar
negative affect.
In other words,
the dietary and psychological factors which predispose to, and
protect from, heart disease, have much in common with those that
predispose and protect from depression.
The good news is
that on a practical level this makes treating both conditions
simpler. Treat one at its cause - that is, not
symptomatically using drugs but through nutrition, lifestyle and
mental retraining - and the other is very likely to improve as well.
You can find out
more about this by participating in any of these programs:
Stress
Inoculation course
Stress Coaching - for executives
Therapeutic Coaching - for the general public
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