Depression and coronary heart disease: A review of the epidemiological evidence, explanatory mechanisms and management approaches
Section snippets
Etiological studies
Table 1 lists the nine systematic reviews of the literature (Bunker et al., 2003, Jiang et al., 2002, Kubzansky and Kawachi, 2000, Kuper et al., 2002, Lett et al., 2004, Musselman et al., 1998, Rozanski et al., 1999), including two meta-analyses (Rugulies, 2002, Wulsin and Singal, 2003), that have investigated the etiological link between depression and CHD in recent years. The 25 individual studies included in these reviews used predominantly community-based samples free of CHD at baseline and
Measurement of depression
As outlined above, in both etiological and prognostic studies depression was defined and measured in a variety of ways rendering comparison across studies problematic. In the vast majority of these studies, the presence of depression was determined by scores on a self-report screening instrument, with higher scores generally considered to indicate major depression and less elevated scores indicating minor depression. While many studies demonstrated a positive correlation and indeed a dose
Proposed mechanisms linking depression and CHD
While the mechanisms linking depression and CHD are not well understood, a number of relationships have been identified which demonstrate the plausibility and coherence of a causal relationship. These include both direct biological mechanisms and indirect pathways mediated through behavioral, lifestyle and social factors. A summary of the evidence for these mechanisms follows.
Interventions for cardiac patients with co-morbid depression
A range of lifestyle, psychosocial and pharmacological interventions has been applied in the management of patients with co-morbid depression. The aim of such interventions is to reduce the increased risk of morbidity and mortality associated with co-morbid depression in cardiac patients. However, the value of treating depression in cardiac patients is increasingly being recognized in its own right. A review of the current evidence for the management of depression in cardiac patients follows.
Discussion
This review has demonstrated that the evidence for a link between depression and CHD is compelling. Depression is a major complicating factor in patients with CHD; at the same time, CHD is a major complicating factor in depression and clinical psychologists need to take account of this in their clinical practice. The increased risk of subsequent morbidity and mortality from CHD associated with depression is in the order of 1.5–2 fold. Depression is even more strongly associated with adverse
Acknowledgment
This review was carried out by the first author in partial fulfillment of the requirements for a Masters in Clinical Psychology from Macquarie University under the supervision of the second author. The authors also thank the NSW Division of the National Heart Foundation of Australia for their support of this review as well as associated work related to the psychosocial needs of patients with heart disease. The authors acknowledge the helpful comments made by two anonymous reviewers.
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