What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiac disease (n=388). Primary outcome: Prevalence of clinically significant depression (PHQ-9 > 9).

January 7, 2019Open Access

Prevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago

Key Result

Among hospitalized patients with stable cardiac disease, the prevalence of clinically significant depression was 40.0%, while non-minimal depression was present in 78.4% of patients.

Study Design

Type

Cross-Sectional (n=388)

Multicenter

Structured PICO

Population

388 hospitalised, stable, adult patients with cardiac disease (mainly ischaemic heart disease, arrhythmias, heart failure, or valvular heart disease) admitted to a tertiary public health institute in South Trinidad. 53.4% female, predominantly aged 45-74 years.

Outcome

Prevalence of clinically significant depression (PHQ-9 > 9) and non-minimal depression (PHQ-9 ≥ 5), and associated factors.patient reported

There is a high prevalence of depression among hospitalized cardiac patients in Trinidad and Tobago, strongly associated with hypertension, stress, and living alone, emphasizing the need for routine psychosocial screening.

Limitations

Single-centre study with a relatively small convenience sample
Exclusion of patients with severe health illnesses may have led to underestimation of depression prevalence
Potential to spuriously inflate somatic symptoms after admission
Depended on patient recall and self-reports
Did not address broader psychosocial issues such as divorce, suicide, unemployment, and crime

Abstract

BACKGROUND: Psychosocial issues are major determinants as well as consequences of cardiovascular disease (CVD). This study sought to assess the prevalence and identify factors associated with depression among patients with cardiac disease in a public health institute in Trinidad and Tobago. METHODS: A cross-sectional study was conducted with a convenience sample of 388 hospitalised, stable, adult patients with cardiac disease admitted in the only tertiary public health institute in South Trinidad. Patients were identified and interviewed 3 to 5 days after admission using a questionnaire comprising questions on demographic, medical, and lifestyle issues and the 9-item Patient Health Questionnaire (PHQ-9). RESULTS: The prevalence of clinically significant depression (PHQ-9 > 9) among hospitalised patients with cardiac disease was 40.0%. However, the prevalence of non-minimal depression (PHQ-9 ≥ 5) in this study was 78.4%. It was greater among women (83.1%) than among men (72.9%). Non-minimal depression was associated with sex (p = 0.015), employment status (p = 0.007), hypertension (p = 0.017), stressful life (p ≤ 0.001), feelings of depression (p ≤ 0.001), regular exercise (p ≤ 0.001), and living alone (p = 0.006). Age, ethnicity, education level, income, or religious affiliations were not associated (p > 0.05) with depression. Participants diagnosed with depression commonly reported feeling tired (81.2%), having trouble sleeping (74.7%), and moving/speaking slowly (73.5%). Patients with self-claimed depression (past or current) were four times more likely to have depression and those with self-reported stress and loneliness were twice as likely to have depression. Employed patients and those who exercised regularly were approximately 50% less likely to have depression. CONCLUSIONS: Clinical depression prevalence among hospitalised patients with cardiac disease was 40.0%. Approximately twice as many (78.4%) had non-minimal depression, with higher prevalence among women. Employment, sex, hypertension, stressful life, feelings of depression, regular exercise, and living alone were associated with non-minimal depression. Patients with self-claimed depression, stress, and those living alone had a much higher likelihood of having depression, while those who were employed and exercised regularly were approximately half as likely to have depression.

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