title: Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart failure.
abstract: BACKGROUND
  Congestive heart failure (CHF) and depression are independently known to result in physical decline and diminished functional capacity in the general population. The prevalence and relationship of depressive symptoms in CHF to physical limitations has not been objectively examined.
  
  
  RESULTS
  The Center for Epidemiological Studies Depression Scale (CES-D) was used to ascertain depressive symptoms in 33 elderly ambulatory individuals with CHF. Self-report assessment of functional status, cardiopulmonary exercise testing (CPX), and measurement of energy expenditure by doubly labeled water and Caltrac Accelerometer (Muscle Dynamics, Torrance, CA) were performed. Depressed and nondepressed groups were compared. Forty-two percent of the patients scored in the depressed range (CES-D score of 16 or greater). There were no differences in demographic variables or severity of illness between the depressed and nondepressed patients. Energy expenditure was comparable across groups. Although obtaining similar maximal heart rate and maximal oxygen consumption (VO2max) on CPX, the depressed group showed less exertion on exercise testing with a significantly lower respiratory quotient (P = .017).
  
  
  CONCLUSIONS
  Depressive symptoms were common and unrelated to the severity of CHF. Although depressed individuals tended to report worse physical functioning than nondepressed individuals, objective assessment of energy expenditure was comparable. Depressed patients appear to underestimate their functional ability. Subsequently, inaccurate assessment of functional status may occur.
authors.affiliation: Department of Psychiatry, University of Medicine and Dentistry New Jersey, Robert Wood Johnson Medical School, New Brunswick 08901, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Skotzko
authors.forename: C
authors.initials: C
authors.lastname: Krichten
authors.forename: G
authors.initials: G
authors.lastname: Zietowski
authors.forename: L
authors.initials: L
authors.lastname: Alves
authors.forename: R
authors.initials: R
authors.lastname: Freudenberger
authors.forename: S
authors.initials: S
authors.lastname: Robinson
authors.forename: M
authors.initials: M
authors.lastname: Fisher
authors.forename: S S
authors.initials: SS
authors.lastname: Gottlieb
mesh_terms: D000203:Activities of Daily Living; D000368:Aged / Q000523:psychology*; D001294:Attitude to Health; D016022:Case-Control Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D004734:Energy Metabolism; D005080:Exercise Test; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires