INTRODUCTION Depression is considered one of the most disabling diseases by year 2020, according to the World Health Organization (WHO) statements. Epidemiological evidences indicate depression as an independent psychosocial risk factor for the morbidity and mortality of heart disease around the world . Although the precise pathophysiological pathways linking these disorders remain unknown, it seems that depression plays a key role in the development of heart disease, since it contributes to the overactive of the hypothalamic-pituitary-adrenocortical axis, platelet activation, and decreased heart rate variability. In 1995, the WHO concluded the largest international multicentric survey on Psychological Problems in General Health Care (PPGHC). The PPGHC searched for the form, frequency, course and outcome of psychological problems commonly seen in primary care facilities . This research had the collaboration of 15 centers from 14 countries: Ankara (Turkey), Athens (Greece), Bangalore (India), Berlin and Mainz (Germany), Ibadan (Nigeria), Manchester (United Kingdom), Nagasaki (Japan), Paris (France), Rio de Janeiro (Brazil), Santiago del Chile (Chile), Seattle (USA), Shangai (China) and Verona (Italy) . It was a cross-sectional study of two stages: first-stage, a total of 25916 consecutive attenders were screened for psychological distress, by using the 12-item General Health Questionnaire (GHQ-12); Patients screened were sampled from the GHQ-12 score strata for the second-stage: the psychiatric interview, using the Composite International Diagnostic Interview – Primary Health Care version (CIDI-PHC). It was applied to 5447 eligible persons for psychiatric assessment of depressive disorders, anxiety disorders, somatization disorders, neurasthenia and alcohol problems, according to the International Statistical Classification of Diseases, 10th Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) diagnostic criteria. The responders were also interviewed about the presence of seven chronic medical conditions: hypertension, diabetes, arthritis, heart disease, bronchitis/emphysema, stomach disorder and common parasitic disease. During the PPGHC project, general practitioners seeing clients at the first-stage, were inquired to answer an encounter form for each patient. It consisted of some sections: reason for contact, level of overall health, physical health status, psychological health status and treatment prescribed. In almost all centers, there was a low rate of mental disorders recognized by doctors, including depressive disorders, comparing to CIDI-PHC data findings. The relationship between depression and heart disease is well documented. Some works compare symptoms of depression with heart disease; others used a variety of scales and instruments for psychiatric morbidity measurement, to study that connection. In the present study, the standardized psychiatric diagnosis for depression, generated from the CIDI-PHC, will be compared with the self-reported diagnosis of heart disease across cultures.

1. 6to. Congreso Virtual de Cardiología - 6th Virtual Congress of Cardiology
Index > 6CVC >Transdisciplinary Cardiology
Brief Communication
Depression and Heart Disease – A Cross Cultural View
Nanhay, Abdon Luiz Gonçalves; Villano, Luiz Augusto
UERJ - University of the State of Rio de Janeiro - Discipline of Psychiatry, Brazil.
Abstract
INTRODUCTION
Depression is considered one of the most disabling diseases by year 2020, according to the World Health Organization
(WHO) statements [9]. Epidemiological evidences indicate depression as an independent psychosocial risk factor for the
morbidity and mortality of heart disease around the world [1,2]. Although the precise pathophysiological pathways linking
these disorders remain unknown, it seems that depression plays a key role in the development of heart disease, since it
contributes to the overactive of the hypothalamic-pituitary-adrenocortical axis, platelet activation, and decreased heart rate
variability [3].
In 1995, the WHO concluded the largest international multicentric survey on Psychological Problems in General Health Care
(PPGHC). The PPGHC searched for the form, frequency, course and outcome of psychological problems commonly seen in
primary care facilities [7]. This research had the collaboration of 15 centers from 14 countries: Ankara (Turkey), Athens
(Greece), Bangalore (India), Berlin and Mainz (Germany), Ibadan (Nigeria), Manchester (United Kingdom), Nagasaki
(Japan), Paris (France), Rio de Janeiro (Brazil), Santiago del Chile (Chile), Seattle (USA), Shangai (China) and Verona
(Italy) [4]. It was a cross-sectional study of two stages: first-stage, a total of 25916 consecutive attenders were screened
for psychological distress, by using the 12-item General Health Questionnaire (GHQ-12)[5]; Patients screened were
sampled from the GHQ-12 score strata for the second-stage: the psychiatric interview, using the Composite International
Diagnostic Interview – Primary Health Care version (CIDI-PHC). It was applied to 5447 eligible persons for psychiatric
assessment of depressive disorders, anxiety disorders, somatization disorders, neurasthenia and alcohol problems,
according to the International Statistical Classification of Diseases, 10th Revision (ICD-10) and the Diagnostic and
Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) diagnostic criteria. The responders were also
interviewed about the presence of seven chronic medical conditions: hypertension, diabetes, arthritis, heart disease,
bronchitis/emphysema, stomach disorder and common parasitic disease.
During the PPGHC project, general practitioners seeing clients at the first-stage, were inquired to answer an encounter
form for each patient. It consisted of some sections: reason for contact, level of overall health, physical health status,
psychological health status and treatment prescribed. In almost all centers, there was a low rate of mental disorders
recognized by doctors, including depressive disorders, comparing to CIDI-PHC data findings.
The relationship between depression and heart disease is well documented. Some works compare symptoms of depression
with heart disease; others used a variety of scales and instruments for psychiatric morbidity measurement, to study that
connection. In the present study, the standardized psychiatric diagnosis for depression, generated from the CIDI-PHC, will
be compared with the self-reported diagnosis of heart disease across cultures.
OBJETIVES:
The present research aims to make a comparison of the prevalence of the ICD-10 Depression diagnosis among self-
reported Heart Disease out-patients by sex and age, from the PPGHC centers.
PATIENTS AND METHODS
The present study investigates ICD-10 Depression on 523 self-reported heart disease patients from 09 centers of the
PPGHC Project: ANKARA (ANK), BERLIN (BER), MAINZ (MAI), MANCHESTER (MAN), NAGASAKI (NAG), PARIS (PAR), RIO
DE JANEIRO (RIO), SANTIAGO (SAN) and SHANGAI (SHA). Centers showing inconsistent data were excluded from this
study. The frequencies and statistical tests were generated by the SPPS8.0 software.The general methodology of the
PPGHC study can be found elsewere[8].
RESULTS
The graphic 1 shows the distribution of the prevalence of depression in heart disease across centers. The highest was 50%
in SANTIAGO, and the lowest 7% in NAGASAKI. Fig 1

2. 6to. Congreso Virtual de Cardiología - 6th Virtual Congress of Cardiology
Figure 1. Prevalence of depresion in heart disease across WHO/PPGHC centres
There is a significant association between Depression an HD in: ANK (OR=2,2; p=0,03), BER (OR=2,6;p=0,002) and
MAINZ (OR=3,0;p=0,006). It was found a tendency of association in PAR (OR=1,5; p=0,3), RIO (OR=1,2;p=0,45), SAN
(OR=1,3; p=0,6) and SHA (OR=1,2; p=0,5). There were no association in MAN (OR=1,0; p=0,98) and in NAG (OR=0,96;
p=0,94). Fig 2
Figure 2. Depression and heart disease association (odds ratio). OR / 95%CI
The frequency of Depression in HD by sex (male vs. female) was higher for females in ANK; BER ; MAI; MAN; PAR and
RIO. Fig 3

3. 6to. Congreso Virtual de Cardiología - 6th Virtual Congress of Cardiology
Figure 3. Distrubution of the frequency of depresion in heart disease by sex
The distribution of Depression in HD by age (<45 years-old vs. >45 years-old) was: ANK 50,0%vs.37,5%; BER 31,6%
vs.27,9%; MAI 37,5%vs.31,8%; MAN 57,1%vs.31,0%; PAR 38,5%vs.42,9%; RIO 47,4%vs.29,8%; SAN 75,0%vs.41,7%;
SHA 8,8%vs.12,0%. Fig 4
Figure 4. Distrubution of the frequency of depresion in heart disease by age
DISCUSSION AND CONCLUSION
Across 09 Primary Care Centers,the prevalence of Depression in HD was very high, ranged from 7,2% (NAGASAKI) to 50%
(SANTIAGO). A significant association between Depression and HD was found in ANK, BER and MAINZ. A tendency of
association in PAR, RIO, SAN and SHA. There were no association in MAN and in NAG. The prevalence of Depression was
higher for Heart Disease females in 06 are centres (ANK, BER, MAI, MAN, PAR and RIO). It was observed a tendency of
Depression to be higher in Heart Disease patients under 45 years-old, in 06centers (ANK, BER, MAI, MAN, RIO and SAN),
as well.
BIBLIOGRAFÍA:
[1] Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and
implications for therapy. Circulation 1999; 99:2192–2217.

4. 6to. Congreso Virtual de Cardiología - 6th Virtual Congress of Cardiology
[2] Jiang W, Krishnan RR, O’Connor CM. Depression and heart disease: evidence of a link, and its therapeutic implications.
CNS Drugs 2002;16:111–127.
[3] Kemp D, Malhotra S, Franco K, Tesar G, Bronson D. Heart disease and depression: Don’t ignore the relationship.
Cleveland Clinic Journal of Medicine September 2003;70 (9):745 -761.
[4] Üstün, T. & Sartorius, N. (Org.). Mental Illness in General Health Care. An International Study. Chichester, England: John
Wiley & Sons - on behalf of the World Health Organization, 1995, p. 1-397..
[5] Goldberg D, Williams P. A User’s Guide to the General Health Questionnaire. Windsor, England: NFER/Nelson: 1988.
[6] World Health Organization. Composite International Diagnostic Interview. Geneva, Switzerland: World Health
Organization. Division of Mental Health: 1989. Publication MNH/NAT/89.
[7] Ormel, J, Von Korff M, Üstün, B Pini S, Korten A, Oldehinkel T. Common Mental Disorders and Disability Across
Cultures. Results From the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA December
14, 1994, 272:(22), 1741-1748.
[8] Von Korff M. & Üstün, T. Methods of the WHO Collaborative Study on ‘Psychological Problems In: General Health Care
in Üstün, T. & Sartorius, N. (Org.). Mental Illness in General Health Care. An International Study. Chichester, England: John
Wiley & Sons - on behalf of the World Health Organization, 1995, p.19.
[9] Murray CJ, Lopez AD, Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global
Burden of Disease Study. Lancet 1997; 349:1436–1442.
PS: UERJ is an Ibero-American Institution.
Publication: September - November/2009
Your questions, contributions and commentaries will be answered
by the lecturer or experts on the subject in the Transdisciplinary Cardiology list.
Please fill in de form and Press the "Send" button.
Question, contribution or
commentary:
Name and Surname:
Country: Argentina
E-Mail address:
Re-type Email address:
Send Erase
© 1994 - 2009 2009 CETIFAC - Bioengineering UNER - 6VCC ISBN 978-987-22746-1-0
Updated: 10/29/2009 - DHTML JavaScript Menu By Milonic.com