Depression Often Untreated in Heart Patients

Cardiologists need to spot warning signs, arrange for help, study suggests

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HealthDay Reporter

FRIDAY, June 10, 2005 (HealthDay News) -- In a sign that some cardiologists might be missing the big picture, new research suggests that only a third of heart disease patients with serious symptoms of depression and anxiety get needed treatment.

The findings are significant because previous studies have linked psychological problems to poorer health and higher death rates in people with heart disease, said study co-author Amy Ferketich, an assistant professor of epidemiology and biostatistics at Ohio State University School of Public Health.

"Patients just aren't being screened," she said. "The physicians are just focused on the problem at hand, and they're not thinking about all of these other factors that could contribute to the condition."

Ferketich and a colleague examined a 2002 federal survey that questioned 17,541 male and female heart patients about their health. The researchers checked to see whether the patients, all over the age of 40, were more likely to have suffered from "psychological distress," a general term that refers to serious symptoms of poor mental health, including sadness, nervousness, restlessness and hopelessness, among others.

While the researchers didn't specifically examine the rate of depression and anxiety, many of the symptoms appear in people with those conditions.

The researchers found that 6.4 percent of heart attack survivors qualified as suffering from psychological distress, compared to 2.8 percent of the healthy population. The numbers were even higher -- as much as 10 percent -- among patients with congestive heart failure.

However, only about one third of patients who reported the symptoms said they'd been treated by a mental-health provider. Research suggests that psychological problems can both contribute to the development of heart disease and aggravate it after it develops, Ferketich said.

The findings appear in the June 9 online issue of the European Heart Journal.

It's not entirely clear how mental illness and heart disease are connected, said Sylvia Wassertheil-Smoller, professor of epidemiology and population health at the Albert Einstein School of Medicine in New York City. Some research suggests that psychological symptoms may contribute to blood clots or make the heart beat less effectively, she said.

Last year, Wassertheil-Smoller and her colleagues published a study in the Archives of Internal Medicine reporting that women with mild and moderate depression are 50 percent more likely to have heart attacks than other women.

Depression and anxiety, of course, are normal responses to traumatic events in life, such as life-threatening illness. Their seriousness "depends on how long you're depressed," Wassertheil-Smoller said. "In most situational depression, such as the death of a spouse, eventually it lifts, you learn to cope and go on with your life. If it doesn't, that's a trouble signal."

And what of the role of heart doctors in detecting psychological problems in their patients?

"It's a big problem," Wassertheil-Smoller said. "They don't have time, certainly with managed care and the emphasis on quick turnaround and high productivity in terms of numbers of patients seen. There's not much time for the doctor to be Dr. Welby and find out what's really bothering you."

On the bright side, doctors have more tools to treat psychological problems, she added. As for solutions, she suggested that nurses and other staff members could help screen patients before they meet with cardiologists. "That might pick up the people who really do need help," she said.

More information

Learn more about heart disease and depression from the National Institute of Mental Health.

SOUCES: Amy Ferketich, assistant professor, epidemiology and biostatistics, Ohio State University School of Public Health, Columbus; Sylvia Wassertheil-Smoller, Ph.D., professor, epidemiology and population health, Albert Einstein School of Medicine, New York City, June 9, 2005, European Heart Journal online

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