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The Role of Cardiovascular Disease in the Identification and Management of Depression by Primary Care Physicians

From the Department of Family Practice and Community Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania (HRB, JJG), and the Department of Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland (DEF).

Objective: The objective of this study was to describe the influence of cardiovascular disease (CVD) on identification and management of depression by primary care physicians.

Method: Three hundred fifty-five adults with and without significant depressive symptoms who were screened in primary care offices and invited to participate completed a baseline in-home assessment. CVD was assessed by self-report and psychologic status was assessed with commonly used, validated standard questionnaires. At the index visit, doctors’ ratings of depression and reports of active management were obtained on 340 of the 355 patients who completed in-home interviews.

Results: Older adults who reported heart failure were more likely to be identified as depressed than were older adults who did not report heart failure (unadjusted odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.13–4.85; Wald ² = 5.20, df = 1, p = 0.023). In multivariate models that controlled for potentially influential characteristics such as age, marital status, education, ethnicity, functional status, level of depression, cognitive impairment, attitudes about depression, use of medical care, and number of medications, the findings remained statistically significant. Among older adults identified as depressed, older adults with heart failure were significantly less likely to be actively managed for depression than were older adults without heart failure (unadjusted OR: 0.33; 95% CI: 0.14–0.76; Wald ² = 6.73, df = 1, p = 0.009). After controlling for potentially influential covariates, these findings remained substantially unchanged.

Conclusions: CVD, in particular heart failure, may influence the identification and management of depression among older patients by primary care physicians. The findings underlie the importance of developing interventions that integrate the management of depression and CVD in primary care settings.

Key Words: Depression • treatment • diagnosis • ischemic heart disease • primary health care

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