Depression as a “cardiovascular” problem in primary care: a population based study

Ryszard Piotrowicz¹⁾

Marcin Wojnar²⁾

Joanna Potocka¹⁾

Aleksander Araszkiewicz³⁾[Author ID1: at Mon Jun 25 15:35:00 2007 ]

-->Wiktor Drozdz[Author ID1: at Mon Jun 25 15:35:00 2007 ][Author ID1: at Mon Jun 25 15:35:00 2007 ]⁴[Author ID1: at Mon Jun 25 15:36:00 2007 ]-->[Author ID1: at Mon Jun 25 15:36:00 2007 ]

¹⁾ Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, National Institute of Cardiology, Warsaw, Poland

²⁾ Chair and Department of Psychiatry, Medical University of Warsaw, Poland

³⁾ Department of Psychiatry, Ludwik Rydygier University of Medical Science, Bydgoszcz, Poland

Ryszard Piotrowicz, M.D., Ph.D.:

Professor of Cardiology, Head of Department

Joanna Potocka, M.D.:

Assistant Professor

Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland

Marcin Wojnar, M.D., Ph.D.:

Associate Professor

Chair and Department of Psychiatry, Medical University of Warsaw,

Nowowiejska 27, 00-665 Warsaw, Poland

Aleksander Araszkiewicz, M.D., Ph.D.:

Professor of Psychiatry, Head of Department

Department of Psychiatry, Ludwik Rydygier [Author ID1: at Mon Jun 25 15:33:00 2007 ]Collegium Medicum Bydgoszcz, Nicolaus Copernicus [Author ID1: at Mon Jun 25 15:33:00 2007 ]University Torun [Author ID1: at Mon Jun 25 15:34:00 2007 ]of Medical Science [Author ID1: at Mon Jun 25 15:33:00 2007 ]Kurpinskiego 19, 85-096 Bydgoszcz, Poland

Wiktor Drozdz, M.D.:[Author ID0: at Thu Nov 30 00:00:00 1899 ]

consultant [Author ID1: at Mon Jun 25 15:36:00 2007 ]in [Author ID1: at Mon Jun 25 15:37:00 2007 ]psychiatry, Clinical Neuropsychology Unit, [Author ID1: at Mon Jun 25 15:36:00 2007 ]Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Sklodowskiej 9, 85-094 Bydgoszcz, Poland[Author ID1: at Mon Jun 25 15:37:00 2007 ]

Correspondence to:

Dr Marcin Wojnar, Department of Psychiatry, Medical University of Warsaw,

Nowowiejska 27, 00-665 Warsaw, Poland

Tel: [phone]; Fax: [phone]

E-mail address: [e-mail]

Abstract

Aims Depression is a significant problem in patients with cardiovascular disease treated in primary care (PC). This study assessed prevalence of depression in cardiovascular patients treated by PC physicians in Poland and evaluated how a screening procedure can facilitate identification of depression in PC.

Methods and Results The study included 4256 consecutive outpatients aged 18-65 years from 178 PC practices in Poland. After each patient completed the Beck Depression Inventory (BDI), PC physicians evaluated somatic disorders and verified diagnosis of depression in patients with BDI scores of more than 12 points, using the MINI interview. Subsequently, patients with high BDI scores were referred for a psychiatric consultation (56% complied). Depression was confirmed in 21% of patients with cardiovascular problems. Among patients who reported cardiac complaints without heart disease, 59% had high BDI scores and were suspected of a “masked” depression. About 90% of concordance was found between the diagnoses of depression made by general practitioners and the diagnoses of psychiatrists.

Conclusion The high comorbidity of cardiovascular disorders and depression as well as frequent occurrence of cardiac complaints without a somatic disease in depressive patients suggest that primary care physicians should apply screening instruments that may help them in diagnosing, and ultimately treating, depression accurately.

Key words: Depression, Cardiovascular disease, Primary care, ScreeningIntroduction

Depression has been ranked as the most common psychiatric disorder in primary care. The 1988-1995 WHO study on mental disorders among primary care patients reported confirmed diagnosis of depression in 12.5% of subjects.
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