Depression in elderly patients with congestive heart failure

Congestive heart failure (CHF) is a major cause of disability, hospitalization, and mortality in the elderly. Psychiatric comorbidity - particularly depression - is reportedly very common among older adults with chronic illnesses, but there have been few studies of depression among CHF patients. In the present pilot study, a structured interview (a modified version of the NIMH Diagnostic Interview Schedule) designed to diagnose current major depressive episodes was administered to a sample of sixty hospitalized patients with CHF aged seventy years or older. Overall, 17 percent of the patients met DSM-III-R criteria for major depressive episode during their index admission for CHF. Taking into account the limits of confidence for this figure, it is substantially higher than the 0.7 percent point prevalence for major depression in this age group found by The National Institute of Mental Health's Epidemiological Catchment Area Study. Whereas the rate was 24 percent among white patients, none of the black patients was found to be depressed (p < .05). There were no differences between the depressed and nondepressed groups with respect to three-month readmission and mortality rates among patients discharged alive, but there were trends toward an increased number of inpatient days at three months and higher mortality among the depressed patients (50%) than among nondepressed patients (29%) at one year. It is concluded that major depression is highly prevalent among elderly patients with CHF. Screening for depression should become a routine part of medical evaluation in this group. Additional research is needed to determine whether depression adversely affects the prognosis of this group.