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Even Mild Depression
Shortens Your Life
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.
Science Blog March 9, 2005
Stephanie Thompson's comments:
Very
interesting news. Prior to this the strongest known correlation was
between hostility and heart deaths. Mild depression
sounds so much more innocuous - but clearly, from this evidence, it is
not.
Increasingly research is revealing many inter-relationships between
depression and heart disease. Not least of these is that so many
of the dietary factors which predispose or protect from heart disease
are the same ones which predispose or protect from depression. It
becomes a tangle of cause and effect, but actually makes treating both
conditions simpler.
For
psychological
therapy and nutritional interventions for depression
in Sydney,
look here:
Therapeutic Coaching
For
enjoyable and educational 'group therapy', look here:
Stress Inoculation course.
