Author + information
- Eva R. Serber, PhD⁎ ()
- ↵⁎The Miriam Hospital and The Warren Alpert Medical School of Brown University, Centers for Behavioral and Preventive Medicine, CORO East, Suite 1B, 167 Point Street, Providence, Rhode Island 02903
I thank Hoen et al. (1) and the Heart and Soul Study for drawing attention to the psychological factors that co-occur with and influence cardiovascular (CV) disease. Hoen et al. (1) reported exciting results with individual symptoms predicting CV events. However, a concern that comes to mind is that the symptoms most significantly associated with CV prognosis are not depression-specific symptoms. The investigators acknowledged this limitation and made efforts to account for it. Yet, despite the acknowledgement, are the researchers really examining depression? These symptoms (i.e., fatigue, appetite problems, and sleeping difficulties) could also be considered symptoms of CV disease, or of any other medical condition (e.g., cancer). This letter is not meant to undermine the importance of these somatic symptoms, as they are important for health, prognosis, and recovery, but rather to bring attention to the fact that this particular investigation does not discuss clinical or diagnosable depression. The investigators' rationale for examining the individual symptoms in light of the heterogeneity of depression and lack of strong treatment effects on CV outcomes is understandable; however, a focus on somatic symptoms may take us away from the original intention: examining depression and CV disease to improve the treatment and outcomes of these patients. In their paper, Hoen et al. (1) include the prevalence of each of the depressive symptoms from the Patient Health Questionnaire, but they do not state the prevalence of meeting criteria for or being clinically relevant and suggestive of major depressive disorder or other depressive disorder on the basis of the scoring and interpretation instructions of the Patient Health Questionnaire (2). The investigators hypothesized in the discussion that the lack of a relationship between cognitive symptoms and CV events may be due to a smaller number of patients reporting cognitive symptoms (p. 843 ). The diagnosis of major depressive disorder requires the presence of cognitive symptoms (must have either depressed mood or anhedonia [loss of interest] most of the time for the past 2 weeks), and dysthymic disorder requires depressed mood (3). Thus, by their own admission, the majority of these patients did not have depression. It would be interesting to examine these 3 somatic symptoms (and the other symptoms of depression) and CV outcomes between CV patients who had diagnosed depression and those who did not. There is solid evidence that symptoms of depression (e.g., depressed mood) and diagnosable depression are risk factors for the development and progression of CV disease. Individual symptoms do not “make depression.” We do not want to be too hasty to ignore or discredit the cognitive symptoms of depression that exist, individually and as they relate to somatic symptoms and CV events, particularly in patients with CV disease.
- American College of Cardiology Foundation
- Hoen P.W.,
- Whooley M.A.,
- Martens E.J.,
- Na B.,
- van Melle J.P.,
- de Jonge P.
- American Psychiatric Association