title: Depressive symptoms and perceived doctor-patient communication in the Heart and Soul study.
abstract: BACKGROUND
  Doctor-patient communication is an important marker of health-care quality. Little is known about the extent to which medical comorbidities, disease severity and depressive symptoms influence perceptions of doctor-patient communication in patients with chronic disease.
  
  
  METHODS
  In a cross-sectional study of 703 outpatients with chronic coronary disease, we evaluated the extent to which patient reports of doctor-patient communication were influenced by medical comorbidities, disease severity and depressive symptoms. We assessed patient reports of doctor-patient communication using the Explanations of Condition and Responsiveness to Patient Preferences subscales from the "Interpersonal Processes of Care" instrument. Poor doctor-patient communication was defined as a score of <4 (range 1 to 5) on either subscale. All patients completed the nine-item Patient Health Questionnaire (PHQ) for measurement of depressive symptoms and underwent an extensive evaluation of medical comorbidities and cardiac function.
  
  
  RESULTS
  In univariate analyses, the following patient characteristics were associated with poor reported doctor-patient communication on one or both subscales: female sex, white or Asian race and depressive symptoms. After adjusting for demographic factors, medical comorbidities and disease severity, each standard deviation (5.4-point) increase in depressive symptom score was associated with a 50% greater odds of poor reported explanations of condition (OR 1.5, 95% CI, 1.2-1.8; p < 0.001) and a 30% greater odds of poor reported responsiveness to patient preferences (OR 1.3, 95% CI, 1.1-1.5; p = 0.01). In contrast, objective measures of disease severity (left ventricular ejection fraction, exercise capacity, inducible ischemia) and medical comorbidities (hypertension, diabetes, myocardial infarction) were not associated with reports of doctor-patient communication.
  
  
  CONCLUSIONS
  In outpatients with chronic coronary heart disease, depressive symptoms are associated with perceived deficits in doctor-patient communication, while medical comorbidities and disease severity are not. These findings suggest that patient reports of doctor-patient communication may partly reflect the psychological state of the patient.
authors.affiliation: Department of Medicine, University of California, San Francisco, Box 1364, San Francisco, CA 94143, USA. yael.schenker@ucsf.edu
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
authors.forename: Anita
authors.initials: A
authors.lastname: Stewart
authors.forename: Beeya
authors.initials: B
authors.lastname: Na
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D010465:Perception; D010817:Physician-Patient Relations; D011446:Prospective Studies; D014705:Verbal Behavior