Coronary heart disease and depression in the elderly--a population- based study

BACKGROUND: Growing interest is nowadays focused on the quality of life ofelderly people who survive with chronic diseases. Coronary heart disease(CHD) is one of the most common diseases among the elderly and may have anunfavourable impact on the patient's emotional well-being. OBJECTIVES: Weaimed to describe the prevalence of depression and the occurrence ofdepressive symptoms among elderly CHD patients, with a special emphasis onthe relations between depression and the severity of CHD, and to find outthe possible association between CHD and depression. METHODS: The study wascarried out at the health centre of the municipality of Lieto, insouth-west Finland. The study population consisted of 488community-dwelling men and 708 women, over 64 years old, from among whomthe participants with CHD (89 men and 73 women) were selected, and for whom178 male and 146 female sex- and age- matched controls (free of CHD) weredrawn from the population. CHD patients were selected on the basis of thepresence of angina pectoris or a past myocardial infarction. Depressivesymptoms were measured with the Zung Self-rating Depression Scale.Depression was described in relation to the severity of dyspnoea and chestpain among patients. The associations between depression and age, health,health behaviour, drugs, functional ability and social, psychosocial andenvironmental factors were analysed by logistic regression analyses.RESULTS: The prevalence of depression was 29% among male patients and 20%among female patients. Depression was significantly more common among maleCHD patients than among male controls (P = 0.011). Among women, depressionwas not associated with CHD. Earlier, depression had gone undiagnosed amongmany CHD patients and controls, especially male patients. Among male CHDpatients, depression was associated with more severe dyspnoea, but nosimilar association was found among female CHD patients. Among men theoccurrence of CHD, physical disability, widowhood or divorce, and amongwomen previous clinical depression, physical disability and the use ofangiotensin-converting enzyme (ACE) inhibitors, were associated withdepression. CONCLUSION: Depression is common among patients with CHD. Itseems that CHD is not an independent factor in the aetiology of depressionamong the elderly. The association of CHD with depression among men isexplained by the acute or chronic psychic stress caused by CHD. It may bethat the more complicated the patient's CHD, the more probable is thepresence of depression.