Older patients' views on the relationship between depression and heart disease.

Abstract

BACKGROUND AND OBJECTIVES: Longitudinal studies have found evidence of associations between coronary heart disease and clinical depression. We sought to understand older patients' views regarding relationships between depression and heart disease to facilitate patient-provider communication about heart disease and depression and to lay the groundwork for designing interventions. METHODS: The design was a qualitative study using semi-structured interviews. In all, 33 primary care patients 65 years and over with dysphoria, anhedonia, hopelessness, worthlessness, or sleep disturbance who were taking at least one medication targeting cardiovascular risk factors were interviewed in the office of their primary care clinician. Participants were asked open-ended questions about depression and heart disease and their treatment. A multidisciplinary research team coded the transcripts and identified key themes. RESULTS: Participants gave clear descriptions of how heart disease can lead to depression and depression can lead to heart disease. Participants supported treating depression immediately in the context of heart disease and generally preferred integrated care. CONCLUSIONS: Depression treatment may be more acceptable if discussed in terms of overall cardiovascular risk. Our results support the integration of depression management with management for risk factors for cardiovascular disease.