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Depression and Gender
Depression is a major concern with heart failure patients. The potentially devastating physical limitations imposed on them often result in highly negative changes in their quality of life.
In the general population, women tend to suffer from depression twice as often as men, and are more likely to suffer from severe depressive episodes with functional impairment [16]. The same ratio appies to heart failure patients
Depression in HF patients has been associated with more frequent hospital visits, a more serious NYHA rating, higher medical costs, and most importantly, higher mortality rates [17][18][19][20][21]
So the question is: do those heart failure patients who end up depressed, do so because they are suffering from more serious health problems? Or, do they simply perceive their health to be worse than others?
One study tested this hypothesis [22]. They took a depressed group of patients who perceived their physical limitations to be worse than other HF patients and subjected them to an exercise stress test where they monitored energy expenditure and LVEF. It turned out that the depressed group of patients had a superior LVEF and showed less signs of exertion.
This study suggests that it is important to consider the idea that a patient’s perception of his/her health is equally as, or even more important than, their actual physiological health in determining the severity of their depression and their overall quality of life. Also, physicians should be aware that this artificially severe health perception can lead to diagnostic errors.
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16. Kornstein SG. Gender differences in depression: implications for treatment. J Clin Psychiatry 1997;58 Supp 15:S12–8.
17. Vaccarino V, Kasl SV, Abramson J, Krumholz HM. Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol 2001;38:199–205.
18. Murberg TA, Bru E. Social relationships and mortality in patients with congestive heart failure. J Psychosom Res 2001;5:521–7.
19. Majani G, Pierobon A, Giardini A, et al. Relationship between psychological profile and cardiological variables in chronic heart failure: the role of patient subjectivity. Eur Heart J 1999;20:1579–86.
20. Sullivan M, Simon G, Spertus J, Russo J. Depression-related costs in heart failure care. Arch Intern Med 2002;162:1860–6.
21. Jiang W, Alexander J, Christopher E, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med 2001;161:1849–56.
22. Skotzko CE, Krichten C, Zietowski G, et al. Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart failure. J Card Fail 2000;6:300–5.
