Comparing Patient and Nurse Specialist Reports of Causative Factors of Depression Related to Heart Failure

The United States currently has 700,000 new heart failure (HF) diagnoses each year (Lloyd-Jones et al., 2009). More than 45% of patients with HF experience repeated episodes of serious depression (Artinian, 2003; Chung et al., 2008; Guck, Elsasser, Kavan, & Barone, 2003), have a 4-fold increase in negative HF outcomes compared with those with no depression (Rutledge, Reis, Linke, Greenberg, & Mills, 2006), and often have higher health costs (Welch, Czerwinski, Ghimire, & Bertsimas, 2009) and reduced quality of life (Lichtman et al., 2008). Depressive symptoms double the risk for mortality and other cardiac events in patients with HF, often exacerbating their HF symptoms (Carney, Freedland,& Jaffe,2009). In longitudinal studies, depressed HF patients were found to (a) be less engaged in essential self-care behaviors, such as maintaining sodium and fluid restrictions and medication regimens (Pandya, Metz, & Patten, 2005); (b) have greater loss of physical function; and (c) die sooner (Jiang et al., 2001; Luttik, Jaarsma, Moser, Sanderman, & van Veldhuisen, 2005). Notably, depression is a strong predictor of repeated HF hospital admissions (Jiang et al., 2001), yet fewer than 25% of HF patients are screened for depression, and even fewer are treated (Heritage, Robinson, Elliott, Beckett, & Wilkes, 2007). Both HF and depression can be characterized by fatigue, loss of energy, poor appetite, sleep disturbances, psychomotor retardation, and concentration deficits. Patients experiencing HF are often not screened for depression because of this overlap of depressive and HF symptoms (Holzapfel et al., 2008). All HF patients should be screened for depressive symptoms because of the negative associations between depressive symptoms and mortality, comorbidities, and poor HF self-management. Although the recent national guidelines from the American Heart Association Prevention Committee, led by nurse practitioners, introduced new recommendations that all patients with heart disease be given a questionnaire to screen for depressive symptoms (Lichtman et al., 2008), many patients are still not screened. Even less common than screening for and treating depressive symptoms is the identification of the causative factors of depressive symptoms from patients’ points of view. The identification of depression and its causative factors is imperative to increase the likelihood of HF patients receiving the proper treatment for depression, considering the untoward impact of depression among these patients. The purpose of this data collection was to screen HF patients for depression, to elicit the causative factors participants self-reported, and to compare those factors identified by a psychiatric nurse specialist during a one-on-one assessment session. Comparing factors identified by participant self-report with those uncovered by a psychiatric nurse specialist will help determine if self-report and one-on-one assessment sessions capture similar details. Further, this project allowed for the completion of validity calculations to determine the adequacy of a relatively new clinical depression-screening questionnaire compared with a depression-screening questionnaire that has been used for decades as the gold standard in many research studies.