The association between depression and death was only seen among patients with heart failure due to coronary heart disease, or ischemic cardiomyopathy, and not in patients with dilated cardiomyopathy, an enlarging of the heart caused by genetic, viral, immune or sometimes unknown factors.
Patients with either heart conditions have high levels of depression, anxiety and physical dysfunction, found study author Stephan Zipfel, M.D., of the University of Heidelberg, Medical Hospital, Germany.
The level of depression, as measured before surgery, was a significant predictor of post-operative survival in ischemic disease. Anxiety levels did not predict poorer survival, according to the study published in the September/October issue of Psychosomatic Medicine.
The study included 103 patients who received a heart transplant, 40 for ischemic cardiomyopathy and 63 for dilated cardiomyopathy. Interviews to assess depression, anxiety and physical complaints were conducted after patients were placed on the waiting list for new hearts, the researchers say.
Thirty nine of the subjects were classified as having high levels of depressive symptoms, while 64 had few symptoms of depression, they found.
"Symptoms of depression and anxiety are frequently encountered in patients awaiting a heart transplantation, with prevalence rates for major depression of 23.7 percent and a further significant increase in depressive symptoms during the waiting period," says Zipfel.
"Both cardiomyopathy subgroups showed significantly increased levels of psychological distress compared with health controls," but the ischemic patients showed more depression and anxiety than the dilated patients did, he says.
The researchers comment that previous study findings suggest that depression can affect heart transplant patients' compliance with important immune-suppression drug regimens required to keep their bodies from rejecting the donated organ. Depressed patients may also fail to follow other risk-reduction strategies recommended by their doctors.
"The purpose of any pretransplant assessment should be the early identification of patients experiencing increased psychosocial distress and who thus may be at risk for a poor psychosocial and somatic outcome," they say.
The study was funded by the medical faculty of the University of Heidelberg.
FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Contact Stephan Zipfel at +49 6221/56-8669 or stefan_zipfel@med.uni-heidelberg.de.
Psychosomatic Medicine: Contact Victoria White at (352) 376-1611, ext. 5300, or visit www.psychosomaticmedicine.org.
Journal
Psychosomatic Medicine