Patterns of Depressive Symptoms in Heart Failure Patients

Abstract

Depression is a common problem in heart failure (HF) patients and leads to worsened health outcomes. A review of studies treating depression in HF patient’s revealed different patterns of depressive symptoms. Using the Biopsychosocial Holistic Model of Cardiovascular Health as the guiding framework, this study aimed to determine: (a) the prevalence of depressive symptoms; (b) determine if there are patterns of depressive symptoms; (c) investigate if the patterns differ by gender or pharmacologic treatment; and (d) determine the cardiovascular health markers and the biological, psychological, and social factors associated with depressive symptoms in HF patients. This descriptive, correlational study was a secondary analysis using data from The Self-Management and Care of Heart Failure Trial. Study subjects (N=198) were enrolled from a Midwestern academic medical center and were assigned randomly to receive standard care or the intervention. Information on depression and pharmacological treatment for depression were obtained with other data (e.g., biologic, social, cardiovascular health status) at five time periods over one year. Descriptive statistics, t-tests, plots, and regression analysis were used for analysis. The Center for Epidemiologic Studies Depression Scale (CES-D) score mean at baseline was 8.94 (SD= 6.55); 42% of the sample were clinically depressed (CES-D Score ≥10). The median CES-D scores at baseline were not statistically significantly different between the intervention and control groups. Both groups had a decrease in depressive symptoms over time. There was not a statistically significant difference in mean CES-D changes scores between the intervention and control groups. The patients in the sample were divided into eight groups based on treatment group, gender, and baseline pharmacologic treatment. Each group experienced a decrease in depressive symptoms over the course of the study. Significant variables in the final regression model included pharmacologic treatment, income sufficiency, and the Social Support Scale. This model accounts for 30% of variance in depressive symptoms in patients with HF. All patients with HF should be screened for depressive symptoms. Health care workers should be aware of a patient’s income sufficiency and social support as these may be closely associated with depressive symptoms.