Abstract
Background: Despite advances in medical therapy heart failure consists a prevalent debilitating disease of poor prognosis, strongly associated with high mortality and morbidity rates. On the same time, depression rates are higher in patients with heart failure than in the general population. Depression may be underdiagnosed and consequently undertreated in the patients, as symptoms can often be similar in the two disease states. Purpose: The purpose of the present study was to explore the frequency of occurrence of depression in patients with heart failure and to evaluate possible precipitating factors. Method and material: Study sample consisted of 139 patients with heart failure, who were hospitalized or visited outpatients' clinics in two major hospitals in Athens. Collection of data was performed using the Zung Self-Rating Depression Scale. Statistical analyses (Student's t-test, One-way ANOVA) were conducted using the Statistical Package for Social Sciences 13.0 (SPSS, Chicago, Il, USA). Results: 110 patients (79.1%) were male and only 29 patients were female, over the age of 40. 71.9% were outpatients, 20.2% were hospitalized in the departments of cardiology, while 7.9% were I.C.U. patients. Analysis of data showed that 34.6% of patients scored lower than 40 in Zung Self-Rating Scale, indicating absence of depression, 27.3% scored 40 to 47, indicating mild depression, 20.9% scored 48 to 55, indicating moderate depression, and 17.2% scored over 56, indicating severe depression. More specifically, it was found that, regarding patients' gender and age, women (p=0.001) and patients over the age of 60 (p=0.001) experienced higher levels of depression, while regarding educational background patients who received only basic education may have been more prone to depression (p=0.05, non-significant). In addition, higher levels of depression were observed for those retired (p=0.028), those living in metropolitan areas (p=0.021), patients at 2 or 3 stage of heart failure (p<0.001), patients who had been diagnosed for over 1 year (p=0.032), as well as those who reported that were less informed about the extent of their condition (p=0.001). Conclusions: The majority of patients with heart failure experience various levels of depression. The main precipitating factors are age, gender, educational and economic status, place of residence, amount of receiving information as well as the stage and the onset of the disease. Nurses and physicians must act towards identification, assessment and management of depression in this clinical population.