Factors associated with clinical depression in heart failure
T Corvera-Tindel, L DoeringAbstract
Abstract
Incidence of depression in heart failure (HF) is shown to be associated with rehospitalization and mortality. In HF, higher social support has been linked with less depressive symptoms. Despite investigations into the influence of age, functional class, and pro-inflammatory cytokines (i.e. tumor necrosis factor-alpha [TNFα] and interleukin-6 [IL6]) on depression, its relationship remains relatively unclear.
Aim
Evaluate the relationship of social support, functional class, and pro-inflammatory cytokines with clinical depression among hospitalized HF patients.
Methods
A cross-sectional study conducted in 116 HF patients: age 67.9 ± 11.2 years, LVEF 37.8% ± 17%); Specific Activity Scale (SAS) I/II- 31 (27%), and III/IV- 71 (73%). Clinical depression was measured by DSMIV Diagnostic Interview Structured Hamilton (DISH) and classified into 3 groups: 0= no depression, 1= minor depression/dysthymia, and 2= major depression. Social support was measured by Medical Outcome Social Support survey (MOSSS). After univariate analysis, multinomial logistic regression was performed to create a model of the relationship of predictor variables and clinical depression groups.
Results
Incidence of clinical depression: 0= 90 (77.6%); 1= 17 (14.8%); 2= 8 (6.9%). Univariate comparison of variables between depression groups: 1) age (F= 6.4, p= .002); 2) TNFα_log transformed (F= .69, p= .5); 3) IL6_log transformed (F= .77, p= .46); 4) MOSSS (F= 2.4, p= .09); 5) SAS (X2= 1.157, p= .56). The overall fit of multinomial logistic regression model for clinical depression with five predictor variables (age, SAS, MOSSS, TNFα_log transformed, and IL6_log transformed) were X² (10, 116) = 30.40, Nagelke R² = .32, p < .001). The clinical depression model likelihood ratio test found 3 significant predictor variables: age= X² (20.75, p= <.001); IL6_log transformed X² (7.6, p= .02); and MOSSS X² (8.00, p= .18). Influence of each significant predictor variable per type of clinical depression is shown in Table 1. The occurrence of major depression increases 20 times with increased IL6 (p= .02); increased age and social support decreases occurrence of major depression by 15% (p= .003) and 51% (p= 0.02), respectively. Functional class and TNFα were not related to either minor or major depression.
Conclusion
Hospitalized HF patients who are younger, with less social support and a high IL6 pro-inflammatory cytokine level, may require more frequent monitoring and early intervention. Our findings may require validation in a larger sample size.Table 1For image description, please refer to the figure legend and surrounding text.