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Differences Between Depressed Patients With Heart Failure and Those With Pulmonary Disease

From the Departments of Psychiatry, and Behavioral Sciences and Medicine, Duke University Medical Center, GRECC VA Medical Center, Durham, North Carolina.

Objective: The objective of this study was to examine differences between depressed medical inpatients with congestive heart failure (CHF) and chronic pulmonary disease (CPD) that could impact the etiology and management of depression in this setting.

Methods: Patients aged 50 years or over consecutively admitted to Duke University Medical Center and three community hospitals were screened for depressive disorder using the Structured Clinical Interview for Depression (SCID-IV). Characteristics of depressed patients with CHF (N = 174) and CPD (N = 527) were compared. Analyses were stratified by type of depressive disorder (major versus minor).

Results: Depressed hospitalized medical patients with CHF and CPD are similar to one another in many respects, particularly with regard to severity of depressive symptoms and shortness of breath. However, patients with CHF in this study had greater medical comorbidity and overall more severe medical illnesses but less severe CHF-specific disease severity compared with patients with CPD. Patients with CPD, however, were more likely to have psychologic risk factors such as a psychiatric history, comorbid psychiatric illness, and stressful life events.

Conclusion: These findings suggest important differences between depressed patients with CHF and those with CPD, perhaps reflecting differences in depression etiology and need for specific strategies for managing depression in each of these conditions.

Key Words: Depression • heart failure • COPD • inpatient • elderly

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