Somatic Versus Cognitive Symptoms of Depression as Predictors of All-Cause Mortality and Health Status in Chronic Heart Failure

萧条(经济学) 心力衰竭 精神科 认知 心理学 体细胞 临床心理学 医学 老年学 内科学 生物化学 基因 宏观经济学 经济 化学
作者
Angélique A. Schiffer,Aline J. Pelle,Otto R.F. Smith,Jos Widdershoven,Eric H. Hendriks,Susanne S. Pedersen
出处
期刊:The Journal of Clinical Psychiatry [Physicians Postgraduate Press, Inc.]
卷期号:70 (12): 1667-1673 被引量:81
标识
DOI:10.4088/jcp.08m04609
摘要

Article AbstractObjective: Depression is a predictor of adverse health outcomes in chronic heart failure (CHF), but it is not known whether specific symptoms drive this relationship. We examined the impact of somatic/affective, cognitive/affective, and total depressive symptoms on all-cause mortality and health status in CHF. Method: Consecutive CHF outpatients (n†‰=†‰366) completed the Beck Depression Inventory. The primary endpoint was all-cause mortality; the secondary endpoint was disease-specific health status, as measured by the Minnesota Living with Heart Failure Questionnaire (n†‰=†‰285) at inclusion and 1-year follow-up. The study was conducted between October 2003 and March 2007. Results: There were 68 (18.6%) deaths (mean†‰±†‰SD follow-up, 37.2†‰±†‰10.6 months). Patients high on somatic/affective depressive symptoms had a greater incidence of mortality compared to patients low on somatic/affective depressive symptoms (31% vs 15%; hazard ratio †‰=†‰2.3; 95% CI, 1.38-3.69; P†‰=†‰.001). There was no significant difference in the incidence of mortality between patients high versus low on cognitive/affective depressive symptoms (23% vs 18%; HR†‰=†‰1.4; 95% CI, 0.80-2.40; P†‰=†‰.25), but there was a significant difference between patients high versus low on total depressive symptoms (24% vs 16%; HR†‰=†‰1.6; 95% CI, 1.01-2.63; P†‰<†‰.05). After adjusting for demographic and clinical characteristics, we found that somatic/affective depressive symptoms predicted all-cause mortality (HR†‰=†‰1.8; 95% CI, 1.03-3.07; P†‰=†‰.04), while cognitive/affective and total depressive symptoms did not. Both dimensions of depressive symptoms predicted disease-specific health status at 1 year. Conclusions: Only somatic/affective depressive symptoms significantly predicted all-cause mortality in CHF. In the context of diagnosing and intervening, awareness of subtypes of depressive symptoms is important. Submitted: August 11, 2008; accepted November 4, 2008. Online ahead of print: July 28, 2009. Corresponding author: Angélique A. Schiffer, PhD, Department of Medical Psychology, TweeSteden Hospital, PO Box 90107, 5000 LA, Tilburg, the Netherlands (aschiffer@tsz.nl).

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