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.
