Mid Sweden University

OBJECTIVE: The aims of this study were to investigate the time-course of depressive mood in patients with coronary artery disease during a secondary prevention rehabilitation program, and to analyse how different pre-treatment levels of depressive mood during a treatment phase were related to the degree of lifestyle change at 36 months follow-up. SUBJECTS: The study group comprised 109 of the original 183 consecutive coronary artery disease patients (91 male and 18 female) of whom 48 recently had experienced an acute myocardial infarction, 36 had been treated with coronary bypass surgery, 13 with percutaneous transluminal coronary angioplasty, and 12 had angina pectoris that had not been invasively treated. The subjects were divided into 3 subgroups based on their pre-treatment level of depressive mood. METHODS: Depressive mood was assessed at baseline, after 4 weeks and 12 months, using the depression subscale of the Hospital Anxiety and Depression scale. Lifestyle changes analysed included diet, smoking, relaxation (stress management) and exercise. RESULTS: Overall depressive mood ratings were significantly lower, both at the 4-week and 12-month assessments, compared with baseline, with the greatest improvements in patients with higher Hospital Anxiety and Depression measured depression. Original levels of depressive mood were not found to influence change of lifestyle habits during a 36-month follow-up period. CONCLUSION: Depressive mood might not be an obstacle to lifestyle changes when participating in a behaviourally oriented rehabilitation program including exercise-training, which might be a component important for improved depressive mood.

The importance of depression in coronary artery disease (CAD) outcomes is being increasingly recognized. The aim of this study was to investigate the power of depression as a predictor of return to work, both at full time and at reduced working hours, within 12 months of participation in a behaviorally oriented rehabilitation program in Sweden. The sample comprised 198 employed patients who had recently experienced an acute myocardial infarction (AMI, n=85), or had been treated with coronary by-pass surgery (CABG, n=73) or coronary angioplasty (PTCA, n=40). The results showed that clinical depression before intervention (16 as measured by the Beck Depression Inventory) exerted a great influence on work resumption both at full-time (odds ratio 9.43, CI=3.15–28.21) and at reduced working-hours (odds ratio 5.44, CI=1.60–18.53), while mild depression (BDI 10–15) influenced only work resumption at full-time (odds ratio 2.89, CI=1.08–7.70). Education and, at full-time hours, age also predicted work resumption. This highlights the importance of depressive symptoms in relation to return to work after a CAD event. More research is needed in order to elaborate the degree to which treatment of depression enhances work resumption rates.

Mellan 17 och 45% av kranskärlspatienter kan sägas vara deprimerade. Cirka hälften av de deprimerade kranskärlspatienterna har tidigare haft depressiva episoder och var tredje anses utveckla depression någon gång under året närmast efter en hjärtinfarkt. Förutom vid hjärtinfarkt är depression också mycket vanligt hos patienter med angina pectoris.

Forty consecutive participants in a comprehensive, behaviourally oriented coronary rehabilitation and secondary prevention program were followed for three years. Changes in depression (as measured with the Beck Depression Inventory) as well as the influence of baseline levels of depression on achieved changes in lifestyle behaviour and on rehabilitation and secondary prevention effects were analyzed. Subjects with moderate levels of baseline depression experienced short-term reductions of depression, which was maintained at the 12-month follow-up. Clinically depressed subjects experienced less positive results, with smaller immediate reductions as well as relapse to baseline levels after 12 months, specifically in non-physical, cognitive-affective depression symptoms. There were, however, no differences in lifestyle changes or in hospital treatment between groups with different pre-treatment depression levels. These results are discussed in relation to earlier research on the detrimental effects of depression on the prognosis of coronary artery disease.

Patients with coronary heart disease (CHD), chronic pain and respiratory disorder were investigated for different patterns of psychological factors. Several psychological factors were measured: depression (using Beck"s "BDI"), anxiety (using Spielberger"s "STAI"), anger (Spielberger"s "AX"), and cynicism (Greenglass & Julkunen"s "CD"). The special psychological pattern in patients with CHD was characterized by an increase in suppressed anger, overall experienced anger, and cynicism. Patients with chronic pain did not show any comparable pattern of elevated psychological factors. The pattern in patients with respiratory disorder was characterized by increased cynicism and, in women, also clinical depression.

443 patients (21-74 yrs old) with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons (18-63 yrs old) and 623 people (30-59 yrs old) from the normal population in Jamtland, Sweden were tested using the Beck Depression Inventory (BDI). The aim of the study was to investigate whether scores on the physical and non-physical components of the BDI differed between patients and other groups, or if only the physical component was significantly higher in the patient group, and if that could be interpreted as symptomatic of physical disease and not of depression. The patients' scores were significantly higher than those of the other 2 groups on the physical component but only higher than the normal population sample on the non-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression.

Examined the factor structure of the Hospital Anxiety and Depression Scale (HAD) using data from 624 male vs female Swedish adults (aged 30-39 vs 40-49 vs 50-59 yrs), and compared the HAD with the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). A secondary aim was to examine the factor structure of the HAD. Results indicate that the factor structure was quite strong, consistently showing 2 factors in the whole sample as well as in the different subsamples. The correlations between the total HAD scale and the BDI and the STAI, respectively, were stronger than those obtained using the different subscales of the HAD (the anxiety and depression subscales). As expected, there was also a stronger correlation between the HAD and the nonphysical items of the BDI. It was somewhat surprising that the factor analyses were consistently extracting 2 factors, "depression" and "anxiety", while on the other hand both the BDI and the STAI tended to correlate more strongly with the total HAD score than with the specific depression and anxiety HAD subscales. Nevertheless, the HAD appeared to be a useful clinical indicator of the possibility of depression and clinical anxiety.