Major depression and physical illness trajectories in heart failure and pulmonary disease.

The purpose of this study was to examine conjoint trajectories of depression-physical illness in elderly medical inpatients with heart failure and/or chronic pulmonary disease and major depression (MDD), and to identify baseline predictors of trajectory. Consecutive medically hospitalized patients over age 50 with heart failure and/or chronic pulmonary disease were screened for MDD using the Structured Clinical Interview for Depression. Patients were re-evaluated at 6, 12, 18, and 24 weeks. Four depression-physical illness conjoint trajectories were examined: depression better, illness better; depression better, illness same; depression same, illness better; and depression same, illness same. Baseline predictors of trajectory were examined. MDD was identified in 413 patients; 352 had at least one follow-up. By 6 weeks, 22.3% improved on both depression and illness and 38.1% improved on neither. By 24 weeks, 45.0% had improved on both and 24.8% on neither. Short-term baseline predictors of trajectory (6 weeks) differed from long-term (12-24 weeks); past psychiatric history, overall medical illness severity, and education were short-term predictors, whereas past psychiatric history, depression treatments, and physical functioning were long-term. Improvements in MDD and physical illness track closely together. Characteristics during baseline hospitalization predict outcome trajectory after discharge, and may be useful in understanding etiology and directing treatment.

Duke Scholars

Author Harold G. Koenig Psychiatry & Behavioral Sciences, Adult Psychiatry & Psychol ...