Goldston Kerrie, Baillie Andrew J
National Heart Foundation of Australia (NSW Division), Australia.
Clin Psychol Rev. 2008 Feb;28(2):288-306. doi: 10.1016/j.cpr.2007.05.005. Epub 2007 May 25.
There is compelling evidence that depression is an independent risk factor for both the development of Coronary Heart Disease (CHD) and for worsening prognosis once CHD is established. Given the increasing awareness of the high prevalence of co-morbid depression in individuals with CHD, clinical psychologists are likely to become increasingly involved in the care of cardiac patients. It is imperative therefore, that they are aware of the complex relationship between depression and CHD and are familiar with the pharmacological and psychological interventions most likely to be effective in these patients. The following review explores the epidemiological evidence for the relationship between depression and CHD, examines the biological, behavioral and social mechanisms that may account for this relationship, and considers the findings of the psychological and pharmacological intervention trials seeking to improve outcomes for depressed cardiac patients. Collaboration across a range of disciplines is needed to establish a program of research and professional education and to develop clinical practice guidelines and pathways which support the implementation of best practice in the assessment and management of co-morbid depression in people with and at risk of CHD. Clinical psychologists are well-equipped to take a lead in this important endeavor.
有令人信服的证据表明，抑郁症是冠心病（CHD）发生的独立危险因素，也是冠心病确诊后预后恶化的独立危险因素。鉴于人们越来越意识到冠心病患者中合并抑郁症的高患病率，临床心理学家可能会越来越多地参与到心脏病患者的护理中。因此，至关重要的是，他们要了解抑郁症与冠心病之间的复杂关系，并熟悉最有可能对这些患者有效的药物和心理干预措施。以下综述探讨了抑郁症与冠心病之间关系的流行病学证据，研究了可能解释这种关系的生物学、行为和社会机制，并考虑了旨在改善抑郁症心脏病患者预后的心理和药物干预试验的结果。需要跨学科合作来建立一个研究和专业教育项目，并制定临床实践指南和路径，以支持在评估和管理冠心病患者及有冠心病风险人群的合并抑郁症时实施最佳实践。临床心理学家完全有能力在这一重要工作中发挥带头作用。
