冠心病抑郁女性中焦虑和心绞痛的高发生率。

Sundel Kristina Lindwall, Stain-Mahngren Rigmor, Andersson Agneta, Aberg-Wistedt Anna, Schenck-Gustafsson Karin

Department of Psychiatry, St. Görans Hospital, Institution for Clinical Neuroscience, The Karolinska Institutet, Stockholm, Sweden.

Gend Med. 2007 Jun;4(2):146-56. doi: 10.1016/s1550-8579(07)80028-3.

BACKGROUND

Depression is an unfavorable state that is difficult to recognize in patients with coronary heart disease (CHD). Little is known about the characteristics of depressed female CHD patients.

OBJECTIVE

The purpose of this study was to investigate the occurrence of depressive symptoms in women entering a cardiac rehabilitation program, and furthermore, to examine whether women who have CHD and depressive symptoms display any unfavorable physical or psychological characteristics that could be helpful in identifying female CHD patients at increased risk of depression.

METHODS

In a Swedish cross-sectional survey of Swedish women entering a randomized, female cardiac rehabilitation trial, patients with a Beck Depression Inventory (BDI) score indicating depression were compared with patients without depressive symptoms.

RESULTS

Of the 121 women with CHD who participated in the study, 23.1% had BDI scores consistent with moderate to severe depression (BDI > or =19). Scores of > or =19 were strongly correlated to established angina pectoris (P = 0.007) and higher rates of anxiety on the Beck Anxiety Inventory (P < 0.001). Depressed women also were more likely to have a family history of heart disease (P = 0.036) and were less likely to care for their health in the future (P = 0.005).

CONCLUSIONS

This study suggests a strong relationship between depression and angina pectoris in women with CHD. The study also confirms previous findings that depressive symptoms are common in women with CHD. Findings of more pronounced cardiac symptoms in depressed women with CHD suggest that depressive symptoms may present differently or alter cardiac symptoms in female CHD patients. Consequently, the occurrence of increased cardiac symptoms indicates the need to screen for depression, whether depressive symptoms are apparent or not. The higher scores for anxiety in depressed women with CHD and their poorer health care practices, in combination with their more pessimistic beliefs about lifestyle changes, highlight the need to identify depression to enhance adherence to treatment regimens in the cardiac rehabilitation process.

背景

抑郁症是一种不良状态，在冠心病（CHD）患者中难以识别。关于患有抑郁症的女性冠心病患者的特征，人们了解甚少。

目的

本研究旨在调查参加心脏康复计划的女性中抑郁症状的发生率，此外，研究患有冠心病且有抑郁症状的女性是否表现出任何不良的身体或心理特征，这可能有助于识别抑郁症风险增加的女性冠心病患者。

方法

在一项对参加随机女性心脏康复试验的瑞典女性进行的瑞典横断面调查中，将贝克抑郁量表（BDI）评分表明有抑郁症的患者与无抑郁症状的患者进行比较。

结果

在参与研究的121名冠心病女性中，23.1%的BDI评分符合中度至重度抑郁症（BDI≥19）。≥19分与已确诊的心绞痛密切相关（P = 0.007），且在贝克焦虑量表上焦虑发生率更高（P < 0.001）。抑郁女性也更可能有心脏病家族史（P = 0.036），且未来照顾自己健康的可能性较小（P = 0.005）。

结论

本研究表明冠心病女性中抑郁症与心绞痛之间存在密切关系。该研究还证实了先前的发现，即抑郁症状在冠心病女性中很常见。患有冠心病的抑郁女性有更明显心脏症状的发现表明，抑郁症状在女性冠心病患者中可能表现不同或改变心脏症状。因此，心脏症状增加表明需要筛查抑郁症，无论抑郁症状是否明显。患有冠心病的抑郁女性焦虑评分较高、医疗保健行为较差，再加上她们对生活方式改变的信念更为悲观，这突出表明需要识别抑郁症以提高心脏康复过程中对治疗方案的依从性。