Turvey Carolyn L, Klein Dawn M, Pies Carla J
Department of Psychiatry, University of Iowa, Iowa City, Iowa 52242-1000, USA.
J Cardiovasc Nurs. 2006 May-Jun;21(3):178-85. doi: 10.1097/00005082-200605000-00005.
This study examines the contribution of attitudes about impairment to the relation between depression and physical impairment in patients with heart failure. It also describes the current status of antidepressant treatment in a sample of outpatients with heart failure.
A total of 32 depressed and 51 nondepressed patients with heart failure were recruited while seeking heart failure treatment in an outpatient heart failure or family practice clinic. Medical, functional, cognitive, and psychological measures were administered at baseline. Depression measures were readministered to the 32 depressed patients at 8, 16, and 24 weeks after the baseline interview.
Attitudes about impairment and perceived social support were the strongest cross-sectional correlates of depression. The strong association between physical impairment and depression was no longer significant after controlling for attitudes about impairment. In addition, attitudes about impairment predicted chronicity of depressive symptoms longitudinally after controlling for baseline depressive symptom severity. The relation between physical impairment and depression in heart failure is strongly related to how patients cope with impairment. These results call for the development of additional interventions to treat depression that focus on the emotional adjustment to physical impairment.
本研究探讨了心力衰竭患者对功能障碍的态度对抑郁与身体功能障碍之间关系的影响。同时，本研究还描述了心力衰竭门诊患者样本中抗抑郁治疗的现状。
在门诊心力衰竭或家庭医疗诊所寻求心力衰竭治疗的患者中，共招募了32名抑郁的心力衰竭患者和51名非抑郁的心力衰竭患者。在基线时进行医学、功能、认知和心理测量。在基线访谈后的第8、16和24周，对32名抑郁患者再次进行抑郁测量。
对功能障碍的态度和感知到的社会支持是抑郁最显著的横断面相关因素。在控制了对功能障碍的态度后，身体功能障碍与抑郁之间的强关联不再显著。此外，在控制了基线抑郁症状严重程度后，对功能障碍的态度在纵向预测了抑郁症状的慢性化。心力衰竭患者身体功能障碍与抑郁之间的关系与患者应对功能障碍的方式密切相关。这些结果呼吁开发更多针对抑郁治疗的干预措施，重点是对身体功能障碍的情绪调整。
