Major depression is common among patients who have been hospitalized with congestive heart failure (CHF), but most older depressed patients receive neither antidepressants nor psychotherapy.
Harold G. Koenig, MD, of Duke University Medical Center, reports in the February issue of the journal, General Hospital Psychiatry, that only 44 percent of depressed CHF patients age 60 or older received any treatment for depression, either during hospitalization or during the year after being discharged.
"Those with major depression - despite a worse diagnosis - were not more likely to receive treatment than those with minor depression," he writes. "This relatively low rate of treatment for depression is cause for concern given its long duration, impact on service use and effects on the quality of life."
He reported that depressed patients were no more likely than nondepressed patients to see mental health specialists either before hospitalization or after being discharged.
Koenig's study, based on records of 542 patients aged 60 and over screened for depression upon admission to Duke University Medical Center, found 58 percent of those admitted for CHF were depressed.
Among the 342 cases that qualified as cases or controls for his study he studied 107 CHF patients, 36.5 percent of whom had major depression - significantly higher than the 25.5 percent depression rate among non-CHF patients.
"(CHF) patients often remained depressed for a prolonged period," Koenig reported, "and over 40 percent failed to remit during the year following discharge.... The only factor that predicted faster time to remission was social support.... Physical health factors did not affect speed of remission, once situational and social factors were controlled."
He noted that for each point of increase on a social support index the speed of remission of depression increased by 16 percent. Among other findings:
During the three months before admission to the hospital, depressed patients averaged two to three times more medical visits than those without depression; even after controlling for the severity of their physical illness, they still saw physicians more often, "suggesting that the depression itself might have contributed to the increased frequency."
Between three and nine months after discharge, patients with major depression were readmitted to the hospital twice as often as nondepressed patients - 55 percent compared to 28 percent between three and six months, 41 percent compared to 18 percent between six and nine months.
Funding for the study was provided by the National Institute of Mental Health and an NIH, NIA Claude D. Pepper Older Americans Independence Centers grant.
Journal
General Hospital Psychiatry