title: Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality.
abstract: OBJECTIVE
  The Psychosocial Factors Outcome Study (PFOS) investigated the prevalence of depression and anxiety and the relationship of psychosocial factors to mortality in outpatients with heart failure (HF).
  
  
  BACKGROUND
  Considerable evidence links psychosocial factors to coronary heart disease mortality and sudden cardiac death (SCD). The contribution of psychosocial factors independent of disease severity to HF outpatient mortality is not well elucidated.
  
  
  METHODS
  Patients (N = 153) from 20 Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) sites participated in the PFOS. SCD-HeFT provided demographic, medical history, and cardiac data. Participants completed questionnaires to assess psychosocial status at PFOS entry.
  
  
  RESULTS
  Depression and anxiety were common in HF outpatients (36% Beck Depression Inventory-II > or = 13; 45% State Trait Anxiety Inventory > or = 40). Depression, anxiety, and social support amount did not differ in the SCD-HeFT treatment groups: implantable cardioverter defibrillator, amiodarone, and placebo medication. Fifteen (9.8%) patients died during mean follow-up at 23.6 months (SD = 8.2). In Cox regression controlling for treatment, depression, anxiety, and social isolation separately predicted mortality; perceived HF-specific functional status did not. Depression (ln) [P = .04, hazard ratio (HR) = 1.81] and social isolation (P = .04, HR = 2.25), but not anxiety, predicted mortality independent of demographics, clinical predictors, and treatment. When simultaneously including significant demographic, clinical, and psychosocial predictors and treatment groups, depression (ln) (P = .022, HR = 2.2) and social isolation (P = .094, HR = 1.75) predicted mortality. All-cause mortality was 12% for depressed patients and 9% for others.
  
  
  CONCLUSIONS
  This study finds a high prevalence of anxiety and confirms the high prevalence of depression in the HF outpatient population. Depression and social isolation predicted mortality independent of demographic and clinical status in HF outpatients.
authors.affiliation: School of Nursing, University of Maryland, Baltimore, MD 21201, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Friedmann
authors.forename: Sue A
authors.initials: SA
authors.lastname: Thomas
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Morton
authors.forename: Deborah
authors.initials: D
authors.lastname: Chapa
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications* / Q000453:epidemiology; D003863:Depression / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012934:Social Isolation / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology