Patient Self-Report Compared to Nurse Assessment of Depression in Heart Failure

HF patients with clinical depression are at greater risk for rehospitalization and have higher mortality rates than those without depression. The purpose of this study was to use content analysis to identify factors that patients report make them feel depressed. Fifty five study participants were screened at baseline for depression using the CES-D. A sub-sample of participants (N =37) was randomized to the intervention group and were screened for depression using the PHQ-9. Participants who scored as having moderate or severe depression on CES-D or the PHQ-9 were referred to the Psychiatric Nurse specialist for assessment (N =20). Content analysis was used to analyze the question on the CES-D: Describe what makes you feel depressed or blue. The results of the identified factors was compared with themes emerged from the nurse’s assessment. CES-D content analysis found that 69% (N =38) of participants reported experiencing depression due to: illness/health; loss of independence; financial concerns, and life stressors. Nurse’s assessments (N=20) identified themes of grief and situational depression (N =5), fatigue/insomnia (N =9), and anger reactions (N =4). Participants also disclosed concerns with concurrent psychiatric illnesses, worry over family, loneliness, and illicit drug use. Psychiatric nurse specialists can identify additional factors contributing to depression and make further treatment recommendations. The patho-physiologic effects of depression on HF suggest the need for future study in this area