Depression in patients with cardiac disease : a cross-sectional study with control

CILJ ISTRAŽIVANJA: Dokazati povezanost depresije i kardiološke bolesti, što je ispitano usporedbom depresije u njih i u bolesnika iz iste bolnice koji imaju neku drugu (gastroenterološku) bolest. USTROJ ISTRAŽIVANJA: Studija je organizirana kao opažajno-presječna studija s kontrolom. Studija je sačinjavala dvije skupine: ispitivanu skupinu, čiji ispitanici imaju pozitivnu kardiološku anamnezu te kontrolnu skupinu. Kontrolnu skupinu predstavljali su gastroenterološki bolesnici koji nisu bili izloženi rizičnom čimbeniku da obole od depresije, to jest nemaju pozitivnu anamnezu kardiološke bolesti. Korišteni su primarni izvori podataka koji su dobiveni primjenom Hamiltonove ljestvice depresije (HAMD-17) na kardiološke i gastroenterološke ispitanike, a unošeni su u prethodno sastavljene tablice. Na temelju kliničkog intervjua za svako od 17 pitanja je odabran odgovarajući odgovor. MJESTO ISTRAŽIVANJA: Klinički Odjel za kardiologiju i Klinički Odjel za gastroenterologiju KBC Split. SUDIONICI: Studijom je obuhvaćeno ukupno 222 ispitanika u razdoblju lipnja 2011. godine, od čega je njih 111 prikupljeno u više navrata na Kardiološkom odjelu a ostalih 111 isto tako na Gastroeneterološkom odjelu KBC-a Split. Kriterij uključenja za kontrolnu skupinu bio je prisutnost gastroenterološke bolesti, a kriterij isključenja prisutnost kardiološke bolesti i maligniteta. Kriterij uključenja za ispitivanu skupinu bio je prisutnost kardiološke bolesti, a kriterij isključenja prisutnost gastroenterološke bolesti i maligniteta. GLAVNE MJERE ISHODA: Za svakoga ispitanika izračunat je ukupan rezultat dobiven uporabom Hamiltonove ljestvice depresije. Podatci su uneseni u Excel tablicu i nakon toga je izvršena statistička obrada podataka. Uporabom Mann – Whitney U testa očekivana je statistički značajnu razlika u rasponu zbroja bodova u bolesnika iz Odjela za kardiologiju u odnosu na bolesnike iz Odjela za gastroenterologiju. REZULTATI: Usporedbom zbroja bodova po Hamiltonovoj ljestvici za depresiju između bolesnika koji su liječeni na Odjelu za gastroenterologiju i bolesnika koji su liječeni na Odjelu za kardiologiju dobivena je statistički značajna razlika između učestalosti depresije u bolesnika s kardiologije u odnosu na gastroenterološke bolesnike (z=3,35; P=0,001). Medijan (raspon) bio je 10 (4-30) za kardiološke bolesnike, a za gastroenterološke bolesnike medijan (raspon) iznosio je 8 (2-26). Dobiven je statistički značajan porast zbroja bodova po Hamiltonovoj ljestvici za depresiju s porastom dobnih skupina (χ2=27,8; P<0,001). ZAKLJUČCI: U ovoj studiji još jednom je dokazana značajna povezanost depresije i kardiološke bolesti. Poznato je kako uspješno liječenje depresije poboljšava kvalitetu života u ovih pacijenata, stoga je bitan zaključak ove studije da je probirni postupak na depresiju u kardioloških bolesnika itekako važan i preporučljiv. Budući da u ovoj studiji uglavnom prevladavaju stariji bolesnici važno je obratiti pažnju i liječiti i ostale bolesti osim kardiološke. One naime često idu u komorbiditetu s depresijom maskirajući i skrivajući njene simptome i time otežavaju sveukupno liječenje.OBJECTIVE: To prove the connection between depression and cardiac disease by comparing depression in patients who had cardiac disease and patients from the same hospital that had some other (gastrointestinal) disease. DESIGN: The study was organised as an observational cross- study which was being held with control. The study consisted of two groups: a study group, whose participants had a positive cardiological history and a control group. The control group was presented by gastrointestinal patients who were not at risk of developing depression, i.e. they did not have a positive cardiological history. Primary resources of information that were used were obtained by applying the Hamilton Scale of Depression (HAM-D-17) on participants with cardiac and gastrointestinal disease. Previously composed tables were used. Based on the clinical interview, for each of the 17 questions asked, an appropriate answer was provided. SETTINGS: The Cardiology ward and the Gastrointestinal ward of Clinical Hospital Centre Split in Split, Croatia. PARTICIPANTS: The study included a total of 222 participants in the period of June, 2011. 111 of them were gathered on the Cardiology ward, the same was done for the remaining 111 patients on the Gastrointestinal ward. The criteria to participate in the control group was presence of a gastrointestinal disease, while the criteria for eliminating participation was the presence of a cardiac disease and malignity. The criteria to participate in the study group was presence of a cardiac disease, while the criteria for elimination was presence of a gastrointestinal disease and malignity. MAIN OUTCOME MEASURES: The total result for each participant is calculated by using the Hamilton Scale of Depression. The data was entered into an Excel table and processed statistically. By using the Mann-Whitney U Test a significant scale difference was expected between the patients on the Cardiology ward and the patients on the Gastrointestinal ward. RESULTS: While comparing the points that were obtained on the Hamilton Scale of depression between the patients treated on the Cardiology ward and the Gastrointestinal ward, a significant larger result is received in patients on the Cardiology ward (z=3,35; P=0,001). The median was 10 (4-30) for the cardiac patients, while for the gastrointestinal patients the median was 8 (2-26). There was also a significant growth in points on the Hamilton Scale of Depression as the age group is higher (χ2=27,8;P