5
November 2009
A new study has found that depression and anxiety are key factors which can predict hospital utilization for
people with chronic heart failure. This paper won the 2009 Australian Health Review student paper award, in the
Undergraduate category.
This study is reported in the most recent edition of the Australian Health Review, the peer reviewed journal of
the Australian Healthcare and Hospitals Association.
"The high incidence of chronic heart failure (CHF) is expected to increase exponentially over the next few
decades as a result of the expanding ageing population and technological advances in medicine that prolong
life. Not only does CHF impact upon quality of life but it brings with it a burden on health care resources,
particularly in relation to expensive hospital readmissions. Emerging literature has suggested that psychological
factors may be significantly related to health, mortality and hospital usage in the CHF population," said lead
author Ms Roslyn C Jenner, School of Psychology and Counselling, Queensland University of Technology.
"This study examined the predictive ability of depression, anger and anxiety on the course of CHF patients as
assessed by the number of readmissions to hospital and the number of days hospitalised over 1 year after
controlling for illness severity.
"The results revealed that depression was predictive of the number of readmissions to hospital, but contrary to
the hypotheses, anger was predictive of length of stay whereas depression was not. Anxiety was not found to
predict number of readmissions to hospital or length of stay in hospital.
"There are physiological and behavioural explanations for the relationship between depression and number of
readmissions to hospital. Physiologically, higher depression rates have been linked to lower immune systems.
As lower immunity is related to greater hospital use, this may explain why depression significantly predicts
hospital readmission rates. Behaviourally, depression has been associated with non-adherence to medications
and consequently lower health functioning. Depression among coronary heart disease patients is also
associated with non-adherence to risk-reducing behaviours such as exercise, cessation of smoking and
attendance at a cardiac rehabilitation program.
"There is also some evidence that the emotion of anger may play a role in health outcomes for coronary heart
disease patients. Anger activates the sympathetic nervous system, increasing cardiovascular reactivity such as
heart rate and blood pressure, as well as increasing cortisol and catecholamine levels. The overall effect of
anger is a flight-or-fight response similar to that of stress which can be detrimental to the health of CHF patients.
The long-term physiological effects produced by anger can also suppress the immune system. Non-adherence
to medication recommendations also seems to be linked to anger and may lead to worsening health and thus
longer readmissions.
"These results have implications for the screening of CHF patients, intervention implementation and financial
resource planning and distribution. We recommend that additional studies be undertaken that assess and
reduce depression, focusing specifically on the effect these reductions have on the number of readmissions and
length of stay in hospital. This has important implications for financial planning for the inevitable increase in the
CHF population expected over the next decade," Ms Jenner said.
For further information/contact: Rosslyn Jenner 0433 080 296
Depression predicts
hospital use for heart
patients
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