Coronary Heart Disease and Depression

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Coronary Heart Disease and Depression

• Robin R. Whitebird PhD
• William A. Rush PhD
• Patrick OConnor MD MPH
• Stephen E. Asche, MA
• Monica R. Rush
• Leif Solberg, MD

HealthPartners Research Foundation
This study was supported by grant HS 09946 from
the U.S. Agency for Healthcare Research and
Quality.
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Purpose

• To assess the relationship between depression and
  important clinical, health status and
  psychosocial indicators in adults with Coronary
  Heart Disease (CHD).

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Project QUEST

• Project QUEST is 4 year multi-site collaborative
  study involving 19 medical groups, 85 clinics,
  700 providers and 7865 patients. The project
  used a combination of survey, chart audit and
  administrative data to study improvement
  strategies that are associated with best quality
  care practices for chronic disease, specifically
  for patients with CHD and/or Diabetes Mellitus.

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Study Population

• Subset of Project QUEST population - patients
  with CHD as determined by ICD9 or procedure
  codes.
• Responded to survey questionnaire and self-report
  of CHD on questionnaire.
• Consented to medical record review and had
  completed audit.
• N 1725

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Hypotheses

• There will be a significant relationship between
  depressive symptoms and clinical outcomes in
  adults with CHD.
• There will be a significant relationship between
  depressive symptoms and perceived health status
  and psychosocial measures in adults with CHD.

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Identification of Depression PHQ2 Cardinal
Signs

• Depressive Mood
• During the past month have you been bothered by
  feeling down, depressed or hopeless? Y/N
• Anhedonia- Lack of Pleasure
• During the past month have you been bothered by
  little interest or pleasure in doing things? Y/N

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Methods

• Bivariate analysis using chi squares and t tests
  to examine relationships between variables.
• Logistic and multiple regression analysis to
  examine the relationship between depression and
  clinical outcomes while controlling for
  demographic factors.

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Demographics
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Demographics
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Demographics
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Results Clinical Outcomes
Adjusted p ns
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Results Health Status Measures
Days per week
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Results Health Status Measures
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Results Primary Care Assessment
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Results Perceived Social Support
(p (p 16
Results Perceptions of CHD
(p (p 17
Conclusions

• Depression was not significantly related to
  clinical outcomes of LDL, SPB or DBP, but was
  significantly related to poorer perceived health
  status measures including decreased physical
  health and physical activity, increased BMI,
  stroke and arthritis and poorer patient
  assessment of their primary health care.

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Conclusions

• Depression was significantly related to lower
  psychosocial functioning including lower
  perceived social support, and strongly held
  beliefs that heart disease is a future threat and
  currently causing problems in a ones life.

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Conclusions

• More effective identification and treatment of
  depression may lead to improvements in perceived
  health status, improved psychosocial health and
  quality of life for patients living with chronic
  heart disease.