“双心医学”模式下社区老年心脏病患者的抑郁症状

梁雪梅 瞿 波 罗晓清 龚 科 刘可智

1 Introduction

There have been considerable literatures which show a relationship between common cardiovascular diseases(CVDs)and depressive disorders.Some studies found that depressive symptoms were associated with hypotension［1-2］.In a community-based study of elderly people，hypotension was found to be associated with increased risk of depressive symptomatology and lower self-esteem［3］.In another study，14%patients with CHD suffered from current(past month)major depression，and 24%had past(but not current)major depression［4］.As for acute coronary syndrome including unstable angina，14.6%patients suffered from moderate/severe depression［5］.

Psycho-Cardiology，which is also called Behavioral Cardiology，is a new discipline to study the relationship between cardiovascular and psychological disorders.The subject represents a concrete application of the Bio-psycho-social medical model to the cardiovascular and psychiatric psychological disorders［6］.Due to the high prevalence of cardiovascular diseases in elderly people，the comorbid depressive symptoms may occur frequently to a great extent.The interaction between them could lead to the deterioration of intrinsic cardiovascular disorders and the deferment or treatmentresistance of the secondary depression［7］.The primary aim of the present study is to investigate the prevalence of CVD and comorbid depression and their association among elderly Chinese people in the community.

2 Methods

2.1 Study population The study population was derived from the community-based survey of people aged above 60 years in Luzhou City of Sichuan province.The total amount of surveyed people was 771.

2.2 Data collection and assessments

①Social-demographic status:a self-made questionnaire was used to investigate and collect the social-demographic data，including age，gender，educational level，occupation，marriage status.②Cardiovascular disease:Current cardiovascular diseases incidentstatusquestionnaire， including hypertension，CHD and angina.We reviewed the clinical documents of every subject.The definition of hypertension，angina and CHD was according to the clinical documental of hospital.③Depressive symptoms:Center for Epidemiologic studies Depression Scale(CES-D)consisted of 20 items was used to assess depressive symptoms［8］.2.3 Statistical analysis The statisticalsoftware SPSS17.0 was used in all analysis.The statistical difference was compared using chi-square test for categorical variables.

3 Results

3.1 General conditions The study sample included 771 subjects.The age ranged 60-84 years(mean age=69.34 years，SD=6.29 years)，and 68.0%were females.

3.2 The prevalence of CVDs The overall prevalence of self-reported cardiovascular disorders was 22.7%，in which the coronary heart disease was 20.5%and the angina was 10.9%.

3.3 The prevalence of depressive symptoms among people with CVD.

Table 1 The prevalence of depressive symptoms by CVD

4 Discussion

In the present study，we found that the prevalence of depressive symptom in the people with CVD was higher(33.1%)than that in people without CVD(18.3%).This result was consistent with many studies.In a Russian study，42%of patients with ischemic heart disease(IHD)had various degrees of depression and anxiety［9］.Chamberlain et al.found that in hospitalized patients with CVD there were 35%depression i-dentified，which independently associated with a 28%increased risk of being hospitalized［10］.In hospitalized patients with heart failure，depressive symptoms were present in 69(67%)patients:35(34%)had mild depressive symptoms，22(21.3%)had moderate symptoms and 12(11.6%)patients presented severe symptoms［11］.In elderly people，there are dramatically multi-morbid conditions，which might include cardiovascular metabolic disorders，anxiety/depression/somatoform disorders and neuropsychiatric disorders.In the opinion of Schafer et al.，48%-50%of the aged were assigned to at least one of the above three multimorbidity patterns［12］.Our data of the prevalence of depressive symptom was much lower than the above studies.This is more likely due to the method of recruitment.The people we investigate were all from the communities and primary health units whose diseases were under a relative remission and might suffer less from it.However，since the highly overlap in the symptomatic presentation of CVD，metabolic disorders and depressive somatic symptoms，the Psycho-Cardiology medical model applied to diagnosis and intervention seems more and more important.

In the present study，the prevalence of depressive symptoms in peoplewith CHDswasthehighest(34.5%)，the next was angina(34.8)and hypertension(25.0%).Angina is a symptomatic CHD，which often presents as acute heart events.The recurrent attacks of acute heart events might lead people to suffer from anxiety disorder and even depression disorder.In Vural＇s research，depressive symptoms were present in 87.8%of patients with CVD.Depression and anxiety disorder may be prevalent in patients who had been treated for acute coronary syndrome(ACS)［13］.In Doering＇s study，61.7%patients who had experienced ACS were found reported persistent symptoms of depression，anxiety，or both，which increased substantially the risk of death in patients after ACS［14-15］.Depression carries an independent two-to four-fold increased risk of early morbidity and mortality after ACS.Depression symptom severity predicts endothelin-1 elevation that has previously been linked to post-ACS survival［16］.Angina is a symptomatic CHD，which often presents as acute heart events.People with CHD might suffer from not only angina but also dyspnoea，chest pain during anger or emotion，irregular heartbeats，perspiration without physical exercise，and jerking of muscles［17］.The recurrent attacks of acute heart events and severe somatic symptoms might lead people to anxiety and even depression.The substantial symptoms and secondary functional impairment were the main cause of depressive symptoms，on which we should lay more stress.

The prevalence of depressive symptoms in people with hypertension was 25.0%，which was higher than that in people without hypertension(18.4%).In Findley＇s study about veterans，persistent depression was significantly more likely among those with multimorbidity than among those with only hypertension［18］.This result is consistent with ours that the prevalence of depressive symptoms in hypertensive individuals might be lower than other cardiovascular conditions or diabetes.In an African study，hypertension was associated with 12-month anxiety disorder but not 12-month depressive disorders or 12-month comorbid anxietydepression，except for the interaction with other chronic physical condition［19］.The relationship between hypertension and depressive disorder is not exactly clear.Someone suggest that depressive symptom is more relevant to the abnormal circadian blood pressure regulation than to hypertension［20］.In our study，we did not investigate people with hypertension only ad hoc.The higher detective rate of depressive symptoms might be due to the complications of it.Further research will be necessary in the subsequent study.

Our results can offer a statistically definitive data for the prevalence of heart-psychological disease among elderly Chinese people living in the general community under the"Psycho-Cardiology"medical model.Further studies might include more variety of diseases and prospective study in order to found the potential regulation of heart-psychological disease.More implications of"Psycho-Cardiology"medical model will be developed in cardiovascular and mental depart-ment under a multi-discipline connective consultant pattern.

［1］Paterniti S，Verdier-Taillefer MH，Geneste C，et al.Low blood pressure and risk of depression in the elderly.A prospective communitybased study［J］.Br J Psychiatry，2000，17(6):464-467.

［2］Pilgrim JA，Stansfeld S，Marmot M.Low blood pressure，low mood［J］.BMJ，1992，304(6819):75-78.

［3］Stroup-Benham CA，Markides KS，Black SA，et al.Relationship between low blood pressure and depressive symptomatology in older people［J］.J Am Geriat Soc，2000，48(3):250-255.

［4］Wulsin LR，Musselman D，Otte C，et al.Depression and whole blood serotonin in patients with coronary heart disease from the Heart and Soul Study［J］.Psychosom Med，2009，71(3):260-265.

［5］Dias CC，Mateus PS，Mateus C，et al.Acute coronary syndrome and depression［J］.Rev Port Cardiol，2005，24(4):507-516.

［6］Hu DY.Comprehensive management for cardiovascular and psycho-mental disorders-the explore of"Psycho-Cardiology"medical model［J］.Chin clin doctor，2006，34(5):2-3.

［7］Koponen H，Jokelainen J，Keinänen-Kiukaanniemi S，et al.Depressive symptoms and 10-year risk for cardiovascular morbidity and mortality［J］.World J Biol Psychiatry，2010，11(6):834-839.

［8］Moullec G，Maïano C，Morin AJ，et al.A very short visual analog form of the Center for Epidemiologic Studies Depression Scale(CES-D)for the idiographic measurement of depression［J］.J Affect Disord，2011，128(3):220-234.

［9］Mamedov MN，Didigova RT，Bulgucheva ZZ.Assessment of psychological status of patients with effort angina［J］.Kardiologiia，2012，52(1):20-5.

［10］Chamberlain AM，Vickers KS，Colligan RC，et al.Associations of preexisting depression and anxiety with hospitalization in patients with cardiovascular disease［J］.Mayo Clin Proc，2011，86(11):1056-1062.

［11］Pena FM，Modenesi Rde F，Piraciaba MC，et al.Prevalence and variables predictive of depressive symptoms in patients hospitalized for heart failure［J］.Cardiol J，2011，18(1):18-25.

［12］Schäfer I，von Leitner EC，Schön G，et al.Multimorbidity patterns in the elderly:a new approach of disease clustering identifies complex interrelations between chronic conditions［J］.PLoS One，2010，5(12):15-17.

［13］Vural M，Acer M，Akbas B.The scores of Hamilton depression，anxiety，and panic agoraphobia rating scales in patients with acute coronary syndrome［J］.Anadolu Kardiyol Derg，2008，8(1):43-47.

［14］Doering LV，Moser DK，Riegel B，et al.Persistent comorbid symptoms of depression and anxiety predict mortality in heart disease［J］.Int J Cardiol，2010，145(2):188-192.

［15］Kronish IM，Rieckmann N，Schwartz JE，et al.Is depression after an acute coronary syndrome simply a marker of known prognostic factors for mortality［J］.Psychosom Med，2009，71(7):697-703.

［16］Burg MM，Martens EJ，Collins D，et al.Depression predicts elevated endothelin-1 in patients with coronary artery disease［J］.Psychosom Med，2011，73(1):2-6.

［17］Sumanen MP，Suominen SB，Koskenvuo MJ，et al.Occurrence of symptoms and depressive mood among working-aged coronary heart disease patients［J］.Health Qual Life Outcomes，2004，8(2):60-62.

［18］Findley P，Shen C，Sambamoorthi U.Multimorbidity and persistent depression among veterans with diabetes，heart disease，and hypertension［J］.Health Soc Work，2011，36(2):109-19.

［19］Grimsrud A，Stein DJ，Seedat S，et al.The association between hypertension and depression and anxiety disorders:results from anationally-representative sample of South African adults［J］.PLoS One，2009，4(5):52-55.

［20］Kario K，Schwartz JE，Davidson KW，et al.Gender differences in associations of diurnal blood pressure variation，awake physical activity，and sleep quality with negative affect［J］.Hypertension，2001，38(5):997-1002.