Depression, physical impairment, and treatment of depression in chronic heart failure.

ABSTRACT

BACKGROUND AND RESEARCH OBJECTIVE: This study examines the contribution of attitudes about impairment to the relation between depression and physical impairment in patients with heart failure. It also describes the current status of antidepressant treatment in a sample of outpatients with heart failure. SUBJECTS AND METHODS: A total of 32 depressed and 51 nondepressed patients with heart failure were recruited while seeking heart failure treatment in an outpatient heart failure or family practice clinic. Medical, functional, cognitive, and psychological measures were administered at baseline. Depression measures were readministered to the 32 depressed patients at 8, 16, and 24 weeks after the baseline interview. RESULTS AND CONCLUSIONS: Attitudes about impairment and perceived social support were the strongest cross-sectional correlates of depression. The strong association between physical impairment and depression was no longer significant after controlling for attitudes about impairment. In addition, attitudes about impairment predicted chronicity of depressive symptoms longitudinally after controlling for baseline depressive symptom severity. The relation between physical impairment and depression in heart failure is strongly related to how patients cope with impairment. These results call for the development of additional interventions to treat depression that focus on the emotional adjustment to physical impairment.