Published online Jun 22, 2017. doi: 10.5498/wjp.v7.i2.106
Peer-review started: January 21, 2017
First decision: February 15, 2017
Revised: March 30, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: June 22, 2017
To identify factors associated with depressive symptoms among inpatients with cardiovascular disease (CVD).
This is a cross-sectional study performed in a subsample of a large cross-sectional research that investigated affective disorders and suicide behaviour among inpatients hospitalized in non-surgical wards of the University Hospital of the Federal University of Minas Gerais from November 2013 to October 2015. Sociodemographic and clinical data were obtained through a structured interview and medical record review. Depression was assessed by the depression subscale of the Hospital Anxiety and Depression Scale, with scores ≥ 8 considered as positive screening for depression. We used the Fageström Test for Nicotine Dependence to characterize nicotine dependence. For assessing resilience and early-life trauma, we used the raw scores of the Wagnild and Young Resilience Scale and Childhood Trauma Questionnaire, respectively.
At endpoint, we included 137 subjects. Thirty-eight (27.7%) subjects presented depressive symptoms and nine (23.7%) of those were receiving antidepressant treatment during hospitalization. The female sex; a lower mean educational level; a greater prevalence of previous suicide attempts; a higher level of pain; a higher prevalence of family antecedents of mental disorders; a lower resilience score; and higher childhood trauma score were the factors significantly associated with screening positive for major depression (P < 0.05). Multivariate analysis demonstrated that the factors independently associated with the depressive symptoms were a higher childhood trauma severity (OR = 1.06; P = 0.004); moderate to severe nicotine dependence (OR = 8.58; P = 0.008); and the number of previous hospital admissions (OR = 1.11; P = 0.034). The obtained logistic model was considered valid, indicating that the three factors together distinguished between having or not depressive symptoms, and correctly classified 74.6% of individuals in the sample.
Our results demonstrate that inpatients presenting both CVD and a positive screening for depression are more prone to have antecedents of childhood trauma, nicotine dependence and a higher number of previous hospitalizations.
Core tip: The prevalence of depression is considerably higher among individuals with cardiovascular diseases (CVD) when compared to the general population. Both major depression and depressive symptoms are predictors of poor outcome in patients with CVD. Depressive disorder is frequently overlooked and untreated in individuals with CVD. Our results demonstrate that inpatients presenting both CVD and a positive screening for depression are more prone to have antecedents of childhood trauma, nicotine dependence and a higher number of previous hospitalizations. Clinicians may consider these factors in the assessment of CVD inpatients at risk for major depression. This measure can improve their treatment approach and patients’ prognosis.