Exploring potential associations of suicidal ideation and ideas of self-harm in patients with congestive heart failure.
OBJECTIVE
To determine the factors, which are associated with suicidal ideation and ideas of self-harm in patients with congestive heart failure (CHF).


METHODS
We examined 294 patients with documented CHF, New York Heart Association (NYHA) functional class II-IV, in a cross sectional study at three cardiac outpatient departments. Measures included self-reports of suicidal ideation and self-harm (PHQ-9), depression (SCID), health-related quality of life (SF-36), multimorbidity (CIRS-G), consumption of alcoholic beverages, as well as comprehensive clinical status. Data were analyzed using logistic regression analyses.


RESULTS
50 patients (17.1%) reported experiencing suicidal ideation and/or ideas of self-harm on at least several days over the past two weeks. The final regression model revealed significant associations with health-related quality of life, physical component (odds ratio [OR] 0.56; 95% confidence interval [CI]: 0.35-0.91), and mental component (OR 0.50; 95% CI: 0.31-0.82), consumption of alcoholic beverages (OR 1.27; 95% CI: 1.05-1.54), first-episode depression (OR 3.92; 95% CI: 1.16-13.22), and lifetime depression (OR 10.89; 95% CI: 2.49-47.72). Age was only significant in the univariable (P=.03) regression analysis. NYHA functional class, left ventricular ejection fraction (LVEF), etiology of CHF, medication, cardiovascular interventions, multimorbidity, gender, and living situation were not significantly associated with suicidal ideation or ideas of self-harm.


CONCLUSIONS
Lifetime depression, in particular, increases the risk of suicidal ideation and ideas of self-harm in CHF patients. Furthermore, the findings of our study underline the necessity of differentiating between first-episode and lifetime depression in CHF-patients in future research and clinical practice.
Lossnitzer
Nicole
N
Department of Psychosomatic and General Internal Medicine, Medical Hospital, University of Heidelberg, Heidelberg, Germany. Nicole_Lossnitzer@med.uni-heidelberg.de
Müller-Tasch
Thomas
T
Löwe
Bernd
B
Zugck
Christian
C
Nelles
Manfred
M
Remppis
Andrew
A
Haass
Markus
M
Rauch
Bernhard
B
Jünger
Jana
J
Herzog
Wolfgang
W
Wild
Beate
B
D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D012803:Sick Role; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology*; D011795:Surveys and Questionnaires; D018487:Ventricular Dysfunction, Left / Q000523:psychology