Depression

IJCS

Editorial

The Complex Relationship Between Emotions and the Heart: Should We Care?

Sarah Fagundes Grobe et al. Lídia Zytynski Moura

Knowing how to live with negative emotions is not easy, and developing mechanisms to overcome them can be even more challenging. The attempt to determine the physical effects of emotions and establish their profound influence on the heart has challenged physicians for centuries. Mood disorders, such as depression and anxiety, significantly impact quality of life and increase morbidity and mortality.

At least 30% of patients diagnosed with heart failure (HF) have depressive symptoms, and these numbers have progressively increased since the 1990s. A meta-analysis found that the rates of mortality and cardiovascular events were twice as high in patients with HF and associated depression, and this was often independent of functional class.^, Some behavioral patterns contribute to these results, since patients with depression or anxiety often do not adhere to pharmacological treatment, are less active, have poor eating habits, and use tobacco.^,

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Original Article

Prevalence and Association Between Cognition, Anxiety, and Depression in Patients Hospitalized with Heart Failure

Vivian L. Soares et al. Carolina Pereira Ana Carla Carvalho Tarsila Perez Mota … Raphaela V. Groehs Fernando Bacal Luciana Diniz Nagem Janot de Matos

Abstract

Background

Cognitive impairment, anxiety, and depression are present in patients with heart failure (HF), but their mutual correlation in hospitalized patients is not well established.

Objectives

The aims of this study were to identify the presence of cognitive impairment and the most affected domain, to investigate possible associations of cognitive impairment with depression and/or anxiety, and to observe whether they correlated with occurrence of readmission within 30 days following hospital discharge.

Methods

This is a prospective observational study including patients with HF from a private hospital. Psychological distress and cognition were evaluated by the Hospital Anxiety and Depression Scale (HADS) and by the Mini Mental State Exam (MMSE), respectively. Clinical data were obtained from the medical record at the time of inclusion, and outpatient follow-up was performed 30 days after discharge via telephone calls.

Results

This study included 71 patients (83% men, 75 ± 11 years). Cognitive impairment was present in 53.5% of the patients, and recall memory was the most altered cognitive domain. The proportion of possible/probable anxiety and depression was 21.1% and 34.2% in patients with cognitive impairment, respectively. However, only depression demonstrated association with cognitive impairment (p = 0.018). Cognitive impairment, anxiety, and depression showed no relationship with the occurrence of readmission within 30 days.

Conclusions

Cognitive impairment and depressive symptoms are prevalent and associated, and recall memory was the most altered cognitive domain in patients hospitalized with HF. However, there was no relationship between these factors and readmission within 30 days.

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Original Article

Cognitive Alterations in Elderly Patients with Heart Failure’

Fernanda Guedes Afiune et al. Salvador Rassi Abrahão Afiune Neto

Abstract

Background:

Among the various pathologies that affect the elderly, Heart Failure (HF) stands out. Recently, an attempt has been made to verify the existence of cognitive impairment associated with HF.

Objectives:

To compare the cognitive performance of elderly people with heart failure with that of age-matched individuals without this pathology. Check the existence of marked impairment in some cognitive functions in the clinical group.

Methods:

The sample consisted of 78 elderly people, whose inclusion criterion was the presence of HF and no HF (control group); age over 60 years, both sexes, and any level of education. The control group consisted of 37 individuals (with a median age of 68 years – Interquartile range of 12) and the HF group, with 41 individuals (with a median age of 67 years – Interquartile range of 11). The subjects were matched in terms of education level, with a predominance of elderly people with 0 to 4 years of education (65.9% in the Clinical Group and 59.5% in the Control Group). Eleven neuropsychological tests covering cognitive functions were used: attention, language, memory, mood, and executive function. Statistical analysis was performed using SPSS software, version 23, with a significance level of 5%. The Chi-square test and the Mann-Whitney test were applied.

Results:

The results showed significant differences between the groups, mainly in executive functions, which include the ability to plan, switch, and recall previously stored information.

Conclusion:

Our study showed differences between the cognitive performance of elderly people with HF and elderly people without HF. The main alteration was found in the so-called executive functions, attention, and memory.

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Original Article

The Effect of Psychotherapy on Anxiety, Depression, and Quality of Life of Patients with Heart Failure: A Randomized Clinical Trial

Isaura Rocha et al. Ana Dantas Cavalcanti Lyvia Figueiredo Juliana Pereira … Samara de Oliveira Danilo da Cruz Rodrigo de Freitas Evandro Tinoco Mesquita

Abstract

Background

Patients with heart failure often experience depression, anxiety, and impacts on quality of life. Psychotherapeutic interventions have been used for chronic conditions, including cardiovascular diseases, showing improvement in mental health. However, no studies have assessed the effects of a psychological intervention using psychoanalysis on patients with heart failure.

Objective

To assess the effect of short-term psychotherapy on depressive symptoms, anxiety, and quality of life of patients seen at a specialty clinic.

Method

A randomized clinical trial with scales to assess outcomes before and after psychotherapy, under the perspective of psychoanalysis, with 12 weekly sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Minnesota Living with Heart Failure Questionnaire were used. The mean initial and final scores for quality of life, anxiety, and depression were compared using Student’s t-test for independent samples when distribution was normal, or Mann-Whitney test when distribution was non-normal. A bivariate p-value < 0.05 was considered statistically significant for all analyses.

Results

This study involved 32 patients, 50% were female, mean age was 64.3±11.6, and most participants were New York Heart Association (NYHA) functional class I (56.3%). For anxiety (p = 0.196), there was no statistically significant difference between groups. For quality of life and depression, there was a statistical difference (p = 0.009 and 0.035, respectively), with a medium effect (Cohen’s d = 0.593) on quality of life.

Conclusion

Short-term psychotherapy in outpatients with heart failure showed an impact on depression and quality of life but did not improve anxiety. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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Editorial

Anxiety, Depression, Stress and the Heart: When Measurement Matters

Cristiano Tschiedel Belem da Silva et al. Rafaela Doebber Escobar

The interplay between cardiovascular symptoms and stress has been a matter of concern for centuries. The first known scientific description of panic disorder, for example, which would nowadays be considered a mixture of panic disorder itself, post-traumatic-stress disorder, cardiac arrhythmia and congestive heart failure, took place in a cohort of three hundred patients of a military hospital in Philadelphia (USA). The name of the new diagnostic entity that followed (“irritable heart syndrome” or simply “Da Costa Syndrome,” named after the author of the original description) is rather an indicator of the historical overlap between cardiovascular diseases (CVD) and psychosocial conditions than properly an example of scientific rigor in describing the discovery of a new medical syndrome.

About sixteen years after the description of the irritable heart syndrome, Augustus Waller, a British physiologist, published the first human electrocardiogram (EKG) applying a capillary electrometer and placing electrodes in the chest and back of an individual. More than half a century after Waller’s publication, the 12-Lead EKG – as we know it now – was standardized by the American Heart Association. Since then, EKG is the most important test for the interpretation of cardiac rhythm and for the detection of myocardial ischemia. In sharp contrast with diagnostic developments in Cardiology and despite a whole new era in neuroimaging, no single physiological marker has emerged to help detecting anxiety disorders or depression in Psychiatry. Nonetheless, the degree to which mental disorders are realized within the brain or in the rest of the body is still unclear.

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Original Article

The Physical Activity Level, Body Composition and Diabetes Mellitus Influence the Association Between Depression and Hypertension in Community-Dwelling Elders

Carlos Geovane S. Araújo et al. Ivna Vidal Freire Ícaro José Santos Ribeiro Yanne Franca Montino … Cézar Augusto Casotti Rafael Pereira

Abstract

Background:

Depression and hypertension are highly prevalent among elderly people. Although the relationship between these conditions is well recognized, however, the factors that may influence such association are not clearly understood.

Objective:

To analyze the association between depression and hypertension in community-dwelling elders.

Methods:

Two-hundred and thirty-one community-dwelling elders provided information regarding the following variables: sex, age, ethnicity, smoking habit, physical activity level (PA), body mass index (BMI) and diabetes mellitus (DM). These variables can potentially influence depression and hypertension, as well as its relationship. Screening for depression was made using the Geriatric Depression Scale (GDS). The presence of hypertension was defined based on self-reported data and/or the use of antihypertensive drugs. The logistic regression technique was applied, using hypertension as the dependent variable and depressive state as a predictive variable. Logistic regression was applied with and without adjustment for the potential intervening variables.

Results:

The prevalence of depressive state and hypertension in the studied population was 14% and 59%, respectively. The association between depression and hypertension without adjustments was not significant (odds ratio [OR] = 2.28, 95% confidence interval [95%CI] = 0.98 – 5.32; p = 0.06). However, after adjusting for PA, BMI and DM, the strength of association between depression and hypertension significantly increased (OR = 3.08, 95%CI = 1.12 – 8.46; p = 0.03).

Conclusion:

The association between depression and hypertension in the elderly is directly influenced by PA, BMI and DM. This finding may guide strategies to increase the adherence to a healthier lifestyle.

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Original Article

Validation of the Brazilian Version of the Screening Tool for Psychosocial Distress (Stop-D) for Cardiac Patients

Isabella Barros Rabelo Gontijo et al. Juciléia Rezende Souza Daniel Fernandes Barbosa Salvador Rassi

Abstract

Background:

Distress has a potentiating effect on complications of heart disease. Early identification of distress and psychosocial management could help patients to deal with the disease and improve their quality of life. However, in Brazil, there is no specific instrument for evaluation of distress in cardiac patients.

Objectives:

To describe the validation process of the Screening Tool for Psychosocial Distress (STOP-D) for the Brazilian population.

Methods:

Cross-sectional, observational study with a quantitative approach. A total of 144 patients (including outpatients and inpatients) were interviewed at the waiting room of the outpatient cardiology clinic or in cardiology wards. Sociodemographic and clinical data were collected, and distress was assessed using two instruments – the Brazilian version of the STOP-D and the Hospital Anxiety and Depression Scale (HADS). First, we performed an exploratory factor analysis and analysis of the accuracy of the STOP-D score by the receiver operating characteristic (ROC) curvet.

Results:

The factorability analysis of the correlation matrix did not detect any factor that made the factorial solution unfeasible. The instrument showed a single-factor nature, confirmed by the criterion of eigenvalues, with an 85% accuracy in predicting distress. A cut-off point of 15.5 was chosen for distress using the ROC curve.

Conclusions:

The Brazilian version of the STOP-D is an adequate instrument for the screening of heart disease patient for distress. It can be easily used by any health professional and would contribute to the promotion of a comprehensive support to cardiac patients.

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Original Article

Moderate-Intensity Walking Training Improves Depressive Symptoms and Pain in Older Adults with Good Quality of Life: A Controlled Randomized Trial

Silvio Lopes Alabarse et al. Hélio José Coelho Júnior Ricardo Yukio Asano Braulio Luna Filho … Wagner Correa Santos Japy Angelini Oliveira Filho

Abstract

Background:

Walking training can be an adequate choice to improve physical and psychological conditions in the elderly. Studies have reported positive changes in the quality of life, depressive symptoms and pain. However, baseline characteristics of volunteers have been controlled, and some of previous studies have not investigated these parameters concomitantly.

Objectives:

To assess the effects of moderate-intensity walking on quality of life, depressive symptoms and physical pain in physically active elderly individuals.

Methods:

Sixty-nine subjects were recruited and allocated into two groups: training group (n = 40) and control group (n = 29). All were evaluated for quality of life, depressive symptoms and pain. Training group underwent 40 minutes of walking (50-70% of maximum heart rate), 3 days a week for 12 weeks. For statistical analysis, we used the Kolmogorov-Smirnov test, Student’s t-test and Split-Plot ANOVA with Bonferroni post hoc, Pearson correlation. Significance level was set at 5%.

Results:

After 12 weeks of training, depressive symptoms and physical pain significantly reduced in the training group (2.7 ± 2.4 to 1.9 ± 1.8 and 4.3 ± 3.1 to 2.8 ± 2.9, respectively) compared with baseline values, and remained unchanged in the control group. There was a positive, moderate correlation between depressive symptoms and pain (r = 0.30).

Conclusion:

physically active elderly individuals with good quality of life show improved depressive symptoms after a short-term moderate-intensity walking training program.

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