Association between depression and worse disease-specific functional status in outpatients with coronary artery disease

Background The objective of this study was to determine if depression is as sociated with worse disease-specific functional status in patients with cor onary artery disease. The study was designed as a cross-sectional survey an d 3-month longitudinal cohort. Methods and Results The study took place in outpatient clinics of 3 Veteran s Administration hospitals. All 7282 enrollees were surveyed and 4560 (62.6 %) returned baseline questionnaires, including a screening instrument for d epression. Thirty-nine percent (n = 1793) reported evidence of coronary art ery disease and 1282 patients (71.5%) returned the Seattle Angina Questionn aire; 1025 patients (80%) completed a subsequent 3-month series of instrume nts. Main outcome measures used were the Seattle Angina Questionnaire, a va lid, reliable, and responsive disease-specific functional status measure fo r patients with coronary disease, and the Mental Health Inventory, a mental health screening instrument from the Short Form-36. Mental Health Inventor y evidence of depression was associated with significantly worse disease-sp ecific functional status. Depressed patients had more physical limitation ( mean difference in Seattle Angina Questionnaire score 16.9, P < .001), more frequent angina (mean difference in Seattle Angina Questionnaire score = 9 .5, P < .001), less satisfaction with their treatment for coronary artery d isease (mean difference in Seattle Angina Questionnaire score = 9.9, P < .0 01), and lower perceived quality of life (mean difference in Seattle Angina Questionnaire score = 16.3, P < .001) than nondepressed patients. Frequenc y of depressive symptoms demonstrated an inverse relation with cardiac-spec ific functional status and when patients' depression status changed over ti me, so did their cardiac-specific health status. Conclusions Depression is associated with significantly more physical limit ation, more frequent angina, less treatment satisfaction, and lower perceiv ed quality of life in outpatients with coronary artery disease.