Patient Perceptions of Comorbid Depression in Heart Disease

Depression is a risk factor for the development of heart disease, as well as for poor prognosis among patients with existing disease. However, clinical trials of treatment of depression in patients with heart disease have not resulted in improved cardiac outcomes, and have demonstrated modest effects on depression. The nature of depression in heart patients must be better understood in order to improve treatment and health outcomes. In samples of patients with medical illness as well as in patients with depression, illness perceptions have been useful in predicting both treatment outcomes and self-management behaviors such as coping and adherence. This is the first study to examine patient perceptions of comorbid depression in heart disease. The purpose of the study was to identify baseline correlates of illness perceptions in the context of a depression treatment study. Results from 112 patients with comorbid depression and heart disease, manifested as stable coronary heart disease or heart failure, show that depression is strongly associated with perceived consequences, but that personality factors are more strongly related to several other illness perception dimensions. Depression history variables did not predict illness perceptions, but moderated the effect of personality on timeline perceptions. Relationships among dimensions of illness perceptions were somewhat consistent with findings from other study populations. This study represents an important first step in clarifying how patients with heart disease conceptualize comorbid depression. Future research is needed to determine if these perceptions predict coping with depression, adherence to treatment, or treatment outcomes.