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作者：Jim Kling  
出處：WebMD醫學新聞

　　April 13, 2010（華盛頓西雅圖）－一項新研究結果顯示，心臟衰竭（HF）患者的焦慮與憂鬱程度可以預測接下來6個月的生理功能下降。這項研究發表於行為醫學會第31屆年會與科學座談會。
　　
　　這項研究收納222位HF患者（33%為女性；年齡平均[標準差]為54[11]歲），後續追蹤164位受試者。
　　
　　以明尼蘇達與心衰竭共存問卷來評估生理功能，將流行病學研究憂鬱指標中的憂鬱症相關項目移除，以避免影響。以醫院焦慮與憂鬱指標中的焦慮分量表來評估焦慮。
　　
　　研究者以等級多變項迴歸來檢定假說，並控制變項，例如HF分級、年齡、性別、教育程度與婚姻狀態、使用精神健康服務、以及試驗前的生理功能。
　　
　　總共有14%受試者表示有輕微的憂鬱；12%表示有中度症狀，29%表示有嚴重症狀。26%病患的焦慮程度介於邊緣，而20%是嚴重的。在另一個模式中，試驗前憂鬱（β= 0.15，P= 0.022）與焦慮（β= 0.21，P= 0.001）預測6個月的生理功能變差。
　　
　　研究者發現，憂鬱與焦慮症狀之間有高度相關（r =0.74，P <0.001），且相信它們可能在預測生理功能的變異上有相當的解釋力。該團隊也研究社會支持的影響，卻發現這並不會影響焦慮與憂鬱對生理功能的效應。
　　
　　洛杉磯南加州立大學精神學助理教授Biing-Jiun Shen博士在發表會中表示，大部分研究已經證實焦慮是死亡率的預測因子，但很少有研究檢驗生活社經因子，以及這些因子是如何與生理功能有關的。Shen博士向Medscape精神學表示，篩檢憂鬱症與焦慮，以及在治療期追蹤這些病患是很重要的。
　　
　　許多臨床醫師持續抗拒這項做法，部分是因為缺乏證據支持篩檢與治療這些狀況會延長生命。
　　
　　聖地牙哥加州大學精神學教授Thomas Rutledge博士，他是發表會的聽眾，他向Medscape精神學表示，另一方面，針對生理功能的影響可能比較吸引醫師們的目光。如果病患們更加投入，他們可能會更能參與心臟復健計畫，且我們知道那些計畫對延長生命來說是真正有好處的。
　　
　　他表示，要明確指出焦慮、憂鬱與HF之間的關係是有困難的。我們如何知道反向關係是否也非真實的，也就是說，生理功能下降不會造成憂鬱與焦慮？Rutledge博士表示，如果他早6個月評估同樣的受試者，或許我們將會學到生理功能的下降將讓這些病患住院，且也會造成他們憂鬱。我們需要時間序列研究來釐清何者先發生。
　　
　　這項研究並未接受商業贊助。Shen博士與Rutledge博士表示沒有相關資金上的往來。


Anxiety and Depression in Heart Failure Patients Predict Physical Decline

By Jim Kling
Medscape Medical News

April 13, 2010 (Seattle, Washington) — Heart failure (HF) patients' levels of anxiety and depression can predict the decline of physical function in the following 6 months, a new study suggests. The research was presented here at the Society of Behavioral Medicine 31st Annual Meeting and Scientific Sessions.

The study included 222 HF patients (33% women; mean [SD] age, 54 [11] years) and follow-up data for 164 subjects.

The Minnesota Living with Heart Failure Questionnaire was used to assess physical functioning, with somatic items of depression removed from the Centers for Epidemiologic Studies Depression Scale to avoid confounding. The Hospital Anxiety and Depression Scale anxiety subscale was used to assess anxiety.

The researchers used hierarchical multiple regressions to test hypotheses and control for variables such as the stage of HF, age, sex, education, marital status, use of mental health services, and baseline physical functioning.

A total of 14% of participants reported mild depression; 12% reported moderate symptoms and 29% had severe symptoms. Anxiety levels were borderline in 26% of patients and severe in 20%. In separate models, baseline depression (β = .15, P = .022) and anxiety (β = .21, P = .001) predicted lower physical function 6 months out.

The researchers found a high correlation (r = .74, P < .001) between depression and anxiety symptoms and believe that they probably account equally in predicting variance in physical functioning. The team also investigated the impacts of social support but found that it did not influence the effect anxiety and depression had on physical functioning.

"Most studies have shown that anxiety is predictive of mortality, but few studies have examined psychosocial factors and [how they] relate to physical functioning," Biing-Jiun Shen, PhD, associate professor of psychology at the University of Southern California, Los Angeles, said during the presentation. "It’s quite important to screen for depression and anxiety and to monitor [patients during treatment]," Dr. Shen told Medscape Psychiatry.

Many physicians continue to resist that approach, in part because of a lack of evidence that screening and treating these conditions lead to prolonged life.

"On the other hand, looking at the possible impact on physical functioning might be something that has more appeal to the physician crowd. If patients are more engaged...they may be better able to participate in cardiac rehab programs, and we know those programs have real benefits in terms of prolonged life," Thomas Rutledge, PhD, professor of psychiatry at the University of California at San Diego and an attendee at the session, told Medscape Psychiatry.

It is also difficult to pinpoint the causal relationship between anxiety and depression and HF, he said. "How do we know the reverse isn’t also true, that physical declines aren’t leading to [depression and anxiety]? If he had measured the same participants 6 months earlier, maybe we would learn that it was physical functioning decline that brought them to the hospital and also caused their depression. We need a time series to be able to tell what’s coming first," Dr. Rutledge said.

The study did not receive commercial support. Dr. Shen and Dr. Rutledge have disclosed no relevant financial relationships.

Society of Behavioral Medicine (SBM) 31st Annual Meeting and Scientific Sessions: Abstract 2092. Presented April 8, 2010.