The American Journal of Medicine
Volume 123, Issue 8 , Pages 683-690, August 2010

Assessing the Presence and Severity of Depression in Subjects with Comorbid Coronary Heart Disease

  • W. Victor R. Vieweg, MD

      Affiliations

    • Department of Psychiatry, Virginia Commonwealth University, Richmond
    • Department of Internal Medicine, Virginia Commonwealth University, Richmond
    • Corresponding Author InformationReprint requests should be addressed to W. Victor R. Vieweg, MD, 17 Runswick Drive, Richmond, VA 23238-5414
    • ,
  • Mehrul Hasnain, MD

      Affiliations

    • Sir Thomas Roddick Hospital, Stephenville and Memorial University of Newfoundland, St John's, Newfoundland, Canada
    • ,
  • Edward J. Lesnefsky, MD

      Affiliations

    • Department of Internal Medicine, Virginia Commonwealth University, Richmond
    • Medical Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond
    • ,
  • Elizabeth E. Turf, PhD

      Affiliations

    • Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond
    • Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond
    • Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond
    • ,
  • Ananda K. Pandurangi, MD

      Affiliations

    • Department of Psychiatry, Virginia Commonwealth University, Richmond

Abstract 

Our understanding of how depression alters the origin and course of coronary heart disease is derived from subjective methodologies. Many psychiatric instruments were not tested for reliability and validity in subjects with comorbid medical illness, particularly coronary heart disease. They largely use scales of categoric or ordinal variables. Instruments used to assess coronary heart disease are considerably more objective and often use interval variables. By searching the websites of Circulation and the Journal of the American College of Cardiology, we entered the word “depression” on August 28, 2009. We ignored articles using “depression” in the context of cardiovascular concepts such as “ST-segment depression.” By searching articles dating back to 1995, we selected publications that studied the prognostic association of depression and coronary heart disease. There were 5 relevant publications: 3 from Circulation and 2 from the Journal of the American College of Cardiology. The methods used to assess coronary heart disease (specifically, myocardial infarction) are largely homogenous across the studies, but the methods used to assess depression are heterogeneous. Parameters used to diagnose myocardial infarction and determine its severity are precise, objective, and reliable, whereas those used to assess depression and its severity exhibit less precision and lack comparable objectivity and reliability. This mismatch may compromise our understanding of the link between coronary heart disease and depression in depressed patients with comorbid coronary heart disease. We propose using precise instruments to identify and quantitate coronary heart disease as outcome variables to assess psychiatric interventions and to better define depression in depressed patients with comorbid coronary heart disease. This should lead to a better understanding of the link between depression and comorbid coronary heart disease.

Keywords: Coronary heart disease, Depression, Major depressive disorder, Psychiatric measures

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 Funding: None.

 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(10)00174-9

doi:10.1016/j.amjmed.2010.01.020

The American Journal of Medicine
Volume 123, Issue 8 , Pages 683-690, August 2010

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