Abstract 10703: Depressed or Not Depressed: Untangling the Somatic Symptom Conundrum in Hospitalized CHD Patients
Background: Assessment of clinical depression in cardiac patients is challenging because somatic depressive symptoms may overlap with somatic cardiac symptoms.
Objectives: 1) To describe the frequency of specific depressive symptoms in hospitalized CHD patients; 2) to explore the relationship of cognitive, somatic, and affective depression symptoms to each other in this population.
Methods: Hospitalized CHD patients enrolled in 3 similar studies were evaluated for clinical depression (n=323; age 64 ± 19 years, 53% male, 31% depressed). Presence of major or minor depression was evaluated by structured clinical interviews. Depressive symptoms were measured by the Hamilton Depression Rating Scale (HDRS) or the Beck Depression Inventory (BDI). Agglomerative hierarchical cluster analysis using the Ward method was performed. Using logistic regression with forced entry and controlling for sex, presence of ACS, and history of depression, the association of specific symptom clusters to presence/absence of clinical depression was assessed.
Results: Fatigue (69%) and sleep disturbance (55%) were the most prevalent symptoms, while guilt (25%) and suicidal symptoms (9%) were the least frequent. Analysis of the dendrogram (Figure) revealed 3 symptom clusters (cognitive/affective, somatic/affective, and somatic). Only presence of ACS (OR = .45, 95% CI .26 - .79, p = .005) and endorsement of cognitive/affective symptoms (OR = 1.41, 95% CI 1.223 - 1.631, p = .000) were significant in the regression model (Chi-Square = 56.4, p < .001). Compared to patients endorsing only somatic or somatic/affective symptoms, patients in the cognitive/affective cluster were more likely to be depressed.
Conclusions: To improve case finding for depression, clinicians should increase their index of suspicion if hospitalized CHD patients exhibit cognitive/affective symptoms. Somatic depressive symptoms do not distinguish depressed from non-depressed patients in this population.
- © 2011 by American Heart Association, Inc.