Self-reported depression in patients with coronary heart disease.

BACKGROUND: Assessing depression in cardiac patients is challenging because somatic symptoms of depression may be the result of physical illness. This study examined self-reported symptoms of depression in patients with cardiovascular disease. METHOD: Three hundred six patients with cardiovascular disease completed the Inventory to Diagnose Depression (IDD), which is a self-report depression scale. RESULTS: Practically all patients reported some symptoms on the IDD, but only a small number had scores in the range suggestive of depression. Somatic symptoms did not contribute disproportionately to depression scores but affective and cognitive symptoms were stronger indicators of depression in these patients. Factor analysis identified one factor that represented a general syndrome of depression. CONCLUSIONS: The results suggest that the IDD has promise as a measure to screen for depression in cardiac patients.

Symptoms of posttraumatic stress disorder following myocardial infarction and coronary artery bypass surgery.

Psychosocial adjustment, particularly posttraumatic stress disorder (PTSD) symptoms, was assessed in a sample of 50 men 6-12 months after initial myocardial infarction (MI) or coronary artery bypass (CABG) surgery. Mean scores on the adjustment measures indicated relatively low levels of distress for the entire group. However, a small number of patients reported clinically significant elevations in anxiety, depression, anger, and ruminative thinking. Using DSM-III-R criteria, four patients met the criteria for PTSD on a self-report checklist. Four patients met the criteria for major depressive disorder on the Inventory to Diagnose Depression. Overall, the findings suggest that posttraumatic stress disorder-like reactions may be an unrecognized problem for some men who sustain an MI or undergo CABG surgery. These traumatic reactions are highly correlated with emotional distress, including depression, generalized anxiety, and anger.

Health maintenance activities of physicians and nonphysicians.

Studying the health maintenance attitudes and behaviors of physicians (MDs) as patients provides information about health maintenance care in a group of individuals where preventive care might flourish. The present study reports the results of a survey of such attitudes and behaviors among 144 university-based MDs and 283 nonphysician doctoral faculty members (non-MDs) from two area universities regarding their personal health maintenance care in 1983. Respondents who reported having a personal MD (44% MDs, 74% non-MDs) were twice as likely to believe they should visit a physician regularly for health maintenance and three times as likely to actually visit a physician for health maintenance as those respondents without a personal physician. Both MDs and non-MDs described the need to visit the doctor more often than they actually reported doing so for health maintenance. However, MDs more often than non-MDs reported receiving the particular health maintenance procedures that are generally considered to constitute essential health maintenance care. A better understanding of health maintenance care by MDs and their non-MD colleagues provides insights into the use and misuse of clinical procedures in the asymptomatic adult.

Physicians' attitudes and practices toward CPR training in family members of patients with coronary heart disease.

A survey of 482 physicians practicing in central and western Massachusetts was carried out to examine attitudes and reported practices toward cardiopulmonary resuscitation (CPR) training for family members of patients with coronary heart disease (CHD). Seventy-nine per cent of physicians felt that CPR training was important for the family members of patients with CHD yet only 6 per cent actually provided information about CPR to families. Further studies are indicated to determine why physician behavior is at odds with their stated beliefs and to guide appropriate remedial action.

Factors affecting cigarette smoking status in patients with ischemic heart disease.

To determine the factors affecting cigarette smoking status after the development of ischemic heart disease, 200 patients were studied who were hospitalized with a coronary event and enrolled in a cardiac rehabilitation program. There were significantly more current smokers (55%) among the 96 patients hospitalized with an initial presentation of a coronary event as compared to the percent of current-smokers (34%) among the 104 patients hospitalized with a recurrent coronary event (p less than 0.01). In addition to the occurrence of a prior event, increasing age also significantly discriminated ex-cigarette smokers from current smokers. Among the patients with a recurrent event ex-smokers (44%) and current smokers (34%) differed significantly with respect to age, education, occupation, negative attitudes towards smoking and peak number of cigarettes smoked. Two models were developed which were able to correctly classify 61.7 and 69.1% of the patients with regard to smoking status.