Holzapfel Nicole, Müller-Tasch Thomas, Wild Beate, Jünger Jana, Zugck Christian, Remppis Andrew, Herzog Wolfgang, Löwe Bernd
Department of Psychosomatic and General Internal Medicine, Medical University Hospital Heidelberg, Germany.
J Affect Disord. 2008 Jan;105(1-3):53-62. doi: 10.1016/j.jad.2007.04.009. Epub 2007 May 23.
Depression often goes undetected and untreated in patients with chronic heart failure (CHF). To investigate whether patients with CHF show a specific profile of depression symptoms, we compared depression symptoms in depressed patients with and without CHF.
Of a total of 921 patients from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic criteria for major depressive disorder and 113 for other depressive disorders. Depressed patients with CHF (n=113) and without CHF (n=137) were compared with respect to severity of individual DSM-IV depressive symptoms, as measured with the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic characteristics as covariates were performed separately for patients with major depressive disorder and other depressive disorders.
Among the patients meeting the criteria for major depressive disorder, patients with CHF reported significantly lower levels of depressed mood (p=.006) and worthlessness/guilt (p=.019) than patients without CHF. In contrast, no significant group differences were found for any of the other depression symptoms. Group comparisons among the patients with other depressive disorders completely replicated these results (p< or =.001, and p=.04, respectively).
Our study population of CHF patients may not be representative for CHF patients recruited in the general population.
The diagnostic features discriminating between depressed patients with and without CHF are the cognitive-emotional symptoms of depression, not the somatic symptoms. This finding may partially explain the low recognition rate of depression in patients with CHF. The different profile of depression symptoms in patients with and without CHF should be considered in diagnosis, treatment and medical education.
慢性心力衰竭（CHF）患者中的抑郁症常常未被发现和治疗。为了调查CHF患者是否表现出特定的抑郁症状特征，我们比较了患有和未患有CHF的抑郁症患者的抑郁症状。
在来自CHF门诊和心身门诊的总共921名患者中，137名符合DSM-IV重度抑郁症诊断标准，113名符合其他抑郁症诊断标准。使用PHQ-9量表，比较了患有CHF的抑郁症患者（n = 113）和未患有CHF的抑郁症患者（n = 137）在DSM-IV各抑郁症状的严重程度。为了对抑郁严重程度进行分层，分别对重度抑郁症患者和其他抑郁症患者进行了以社会人口统计学特征为协变量的协方差分析。
在符合重度抑郁症标准的患者中，患有CHF的患者报告的抑郁情绪水平（p = 0.006）和无价值感/内疚感（p = 0.019）显著低于未患有CHF的患者。相比之下，在其他任何抑郁症状方面均未发现显著的组间差异。其他抑郁症患者的组间比较完全重复了这些结果（分别为p≤0.001和p = 0.04）。
我们研究中的CHF患者群体可能不代表从普通人群中招募的CHF患者。
区分患有和未患有CHF的抑郁症患者的诊断特征是抑郁症的认知-情感症状，而非躯体症状。这一发现可能部分解释了CHF患者中抑郁症的低识别率。在诊断、治疗和医学教育中应考虑患有和未患有CHF的患者抑郁症状的不同特征。
