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Depression and Anxiety Predict Decline in Physical Health Functioning in Patients with Heart Failure

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Few studies have examined the prospective influences of depression and anxiety on physical health functioning in heart failure (HF) patients. Prior studies were also limited by employing psychological measures containing somatic items confounded with HF symptoms.

Purpose

This study examined whether depression, anxiety, social support, and their changes predicted the decline of physical functioning in HF patients over 6 months.

Methods

Participants were 238 HF patients among whom 164 provided follow-up data. The depression and anxiety measures did not contain somatic items.

Results

After controlling for baseline physical functioning and demographic and medical covariates, baseline depression and its increase, as well as baseline anxiety and its increase, independently predicted greater decline in physical functioning at 6 months. Social support and its change were not associated with either concurrent or follow-up physical functioning.

Conclusions

Depression, anxiety, and their changes independently predicted the decline of physical health functioning over 6 months.

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References

  1. AHA: Heart disease and stroke statistics—2009 update: American Heart Association, 2009.

  2. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ: Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006, 48:1527–1537.

    Article  PubMed  Google Scholar 

  3. Haworth JE, Moniz-Cook E, Clark AL, et al.: Prevalence and predictors of anxiety and depression in a sample of chronic heart failure patients with left ventricular systolic dysfunction. Eur J Heart Fail. 2005, 7:803–808.

    Article  PubMed  CAS  Google Scholar 

  4. Friedmann E, Thomas SA, Liu F, et al.: Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality. Am Heart J. 2006, 152:940 e941–e948.

    Google Scholar 

  5. De Jong MJ, Moser DK, An K, Chung ML: Anxiety is not manifested by elevated heart rate and blood pressure in acutely ill cardiac patients. European Journal of Cardiovascular Nursing. 2004, 3:247–253.

    Article  PubMed  Google Scholar 

  6. Albert NM, Fonarow GC, Abraham WT, et al.: Depression and clinical outcomes in heart failure: An OPTIMIZE-HF analysis. Am J Med. 2009, 122:366–373.

    Article  PubMed  Google Scholar 

  7. Faller H, Stork S, Schowalter M, et al.: Depression and survival in chronic heart failure: Does gender play a role? Eur J Heart Fail. 2007, 9:1018–1023.

    Article  PubMed  Google Scholar 

  8. Frasure-Smith N, Lesperance F, Habra M, et al.: Elevated depression symptoms predict long-term cardiovascular mortality in patients with atrial fibrillation and heart failure. Circulation. 2009, 120:134–140, 133p following 140.

    Google Scholar 

  9. Jiang W, Alexander J, Christopher E, et al.: Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med. 2001, 161:1849–1856.

    Article  PubMed  CAS  Google Scholar 

  10. Jiang W, Kuchibhatla M, Cuffe MS, et al.: Prognostic value of anxiety and depression in patients with chronic heart failure. Circulation. 2004, 110:3452–3456.

    Article  PubMed  CAS  Google Scholar 

  11. Junger J, Schellberg D, Muller-Tasch T, et al.: Depression increasingly predicts mortality in the course of congestive heart failure. Eur J Heart Fail. 2005, 7:261–267.

    Article  PubMed  Google Scholar 

  12. Sherwood A, Blumenthal JA, Trivedi R, et al.: Relationship of depression to death or hospitalization in patients with heart failure. Arch Intern Med. 2007, 167:367–373.

    Article  PubMed  Google Scholar 

  13. Tsuchihashi-Makaya M, Kato N, Chishaki A, Takeshita A, Tsutsui H: Anxiety and poor social support are independently associated with adverse outcomes in patients with mild heart failure. Circ J. 2009, 73:280–287.

    Article  PubMed  Google Scholar 

  14. Bekelman DB, Havranek EP, Becker DM, et al.: Symptoms, depression, and quality of life in patients with heart failure. J Card Fail. 2007, 13:643–648.

    Article  PubMed  Google Scholar 

  15. Faller H, Stork S, Schuler M, et al.: Depression and disease severity as predictors of health-related quality of life in patients with chronic heart failure—a structural equation modeling approach. J Card Fail. 2009, 15:286–292 e282.

    Article  PubMed  Google Scholar 

  16. Gottlieb SS, Khatta M, Friedmann E, et al.: The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol. 2004, 43:1542–1549.

    Article  PubMed  Google Scholar 

  17. Muller-Tasch T, Peters-Klimm F, Schellberg D, et al.: Depression is a major determinant of quality of life in patients with chronic systolic heart failure in general practice. J Card Fail. 2007, 13:818–824.

    Article  PubMed  Google Scholar 

  18. Vaccarino V, Kasl SV, Abramson J, Krumholz HM: Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol. 2001, 38:199–205.

    Article  PubMed  CAS  Google Scholar 

  19. Clarke SP, Frasure-Smith N, Lesperance F, Bourassa AG: Psychosocial factors as predictors of functional status at 1 year in patients with left ventricular dysfunction. Research in Nursing and Health. 2000, 23:290–300.

    Article  PubMed  CAS  Google Scholar 

  20. Chung ML, Moser DK, Lennie TA, Rayens MK: The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: Testing dyadic dynamics using Actor-Partner Interdependence Model. J Psychosom Res. 2009, 67:29–35.

    Article  PubMed  Google Scholar 

  21. Muller-Tasch T, Frankenstein L, Holzapfel N, et al.: Panic disorder in patients with chronic heart failure. J Psychosom Res. 2008, 64:299–303.

    Article  PubMed  Google Scholar 

  22. Murberg TA: Long-term effect of social relationships on mortality in patients with congestive heart failure. Int J Psychiatry Med. 2004, 34:207–217.

    Article  PubMed  Google Scholar 

  23. Bennett SJ, Perkins SM, Lane KA, et al.: Social support and health-related quality of life in chronic heart failure patients. Qual Life Res. 2001, 10:671–682.

    Article  PubMed  CAS  Google Scholar 

  24. Rector TS, Kubo SH, Cohn JN: Patients' self-assessment of their congestive heart failure. Part 2: Content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire Heart Failure. 1987:198–209.

  25. Rector TS, Cohn JN: Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J. 1992, 124:1017–1025.

    Article  PubMed  CAS  Google Scholar 

  26. Garin O, Ferrer M, Pont A, et al.: Disease-specific health-related quality of life questionnaires for heart failure: A systematic review with meta-analyses. Qual Life Res. 2009, 18:71–85.

    Article  PubMed  Google Scholar 

  27. Radloff LS: The CES-D scale: A self report depression scale for research in general populations. Applied Psychological Measurement. 1977, 1:385–401.

    Article  Google Scholar 

  28. Radloff LS, Locke BZ: The Community Mental Health Assessment Survey and the CES-D Scale. In M. M. Weissman, J. K. Myers and C. E. Ross (eds), Community Surveys of Psychiatric Disorders. New Brunswick, NJ: Rutgers University Press, 1986, 177–189.

    Google Scholar 

  29. Callahan CM, Wolinsky FD. The effect of gender and race on the measurement properties of the CES-D in older adults. Med Care. Apr 1994, 32: 341–356.

    Article  PubMed  CAS  Google Scholar 

  30. Knight RG, Williams S, McGee R, Olaman S. Psychometric properties of the Centre for Epidemiologic Studies Depression Scale (CES-D) in a sample of women in middle life. Behav Res Ther. Apr 1997, 35: 373–380.

    Article  PubMed  CAS  Google Scholar 

  31. Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983, 67:361–370.

    Article  PubMed  CAS  Google Scholar 

  32. Sherbourne CD, Stewart AL: The MOS social support survey. Soc Sci Med. 1991, 32:705–714.

    Article  PubMed  CAS  Google Scholar 

  33. Riedinger MS, Dracup KA, Brecht ML et al.: Quality of life in patients with heart failure: Do gender differences exist? Heart Lung. 2001, 30:105–116.

    Article  PubMed  CAS  Google Scholar 

  34. Rumsfeld JS, Havranek E, Masoudi FA, et al.: Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. J Am Coll Cardiol. 2003, 42: 1811–1817.

    Article  PubMed  Google Scholar 

  35. Cress ME, Schechtman KB, Mulrow CD, et al.: Relationship between physical performance and self-perceived physical function. J Am Geriatr Soc. 1995, 43:93–101.

    PubMed  CAS  Google Scholar 

  36. Watson D & Pennebaker JW: Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychol Rev. 1989, 96:235–254.

    Article  Google Scholar 

  37. Juenger J, Schellberg D, Kraemer S, et al.: Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart. 2002, 87: 235–241.

    Article  PubMed  CAS  Google Scholar 

  38. Rodriguez-Artalejo F, Guallar-Castillon P, Pascual CR, et al.: Health-related quality of life as a predictor of hospital readmission and dealth among patients with heart failure. Arch Intern Med. 2002, 165: 1274–1279.

    Article  Google Scholar 

  39. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L: The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology. J Am Coll Cardiol. 2005, 45:637–651.

    Article  PubMed  Google Scholar 

  40. Kubzansky LD, Kawachi I, Weiss ST, Sparrow D: Anxiety and coronary heart disease: A synthesis of epidemiological, psychological, and experimental evidence. Ann Behav Med. 1998, 20:47–58.

    Article  PubMed  CAS  Google Scholar 

  41. DiMatteo MR, Lepper HS, Croghan TW: Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000, 160:2101–2107.

    Article  PubMed  CAS  Google Scholar 

  42. Ziegelstein RC, Fauerbach JA, Stevens SS, et al.: Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med. 2000, 160:1818–1823.

    Article  PubMed  CAS  Google Scholar 

  43. House JS, Umberson D, Landis KR: Structures and processes of social support. Annual Review of Sociology. 1988, 14:293–318.

    Article  Google Scholar 

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Acknowledgments

The authors would like to extend our gratitude to Drs. Nanette H. Bishopric, M.D., Martin S. Bilsker, M.D., Javier Jimenez, M.D., Ph.D., Sharon Andrade-Bucknor, M.D., and Jay S. Kerzner, M.D., at University of Miami Miller School of Medicine and Dr. Michelle Lister, M.D., at Miami International Cardiology for their assistance in recruiting the participants.

This work was supported by a grant from the American Heart Association and an award from the National Alliance for Research on Schizophrenia and Depression.

Conflict of Interest Statement

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Southern California, 3620 South McClintock Ave., Los Angeles, CA, 90089-1061, USA

    Biing-Jiun Shen PhD, Stacy A. Eisenberg MA & Uta Maeda MA

  2. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Kristin A. Farrell MS & Frank J. Penedo PhD

  3. Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Ernst R. Schwarz MD, PhD

  4. School of Medicine, University of Miami, Miami, FL, USA

    Eugene J. Bauerlein MD & Stephen Mallon MD

Authors
  1. Biing-Jiun Shen PhD
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  2. Stacy A. Eisenberg MA
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Correspondence to Biing-Jiun Shen PhD.

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Shen, BJ., Eisenberg, S.A., Maeda, U. et al. Depression and Anxiety Predict Decline in Physical Health Functioning in Patients with Heart Failure. ann. behav. med. 41, 373–382 (2011). https://doi.org/10.1007/s12160-010-9251-z

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  • DOI: https://doi.org/10.1007/s12160-010-9251-z

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