Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles.
OBJECTIVE
To review evidence regarding the prevalence, causation, clinical implications, aspects of healthcare utilisation and management of depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease.


METHODS
A critical review of the literature (1994-2009).


RESULTS
The prevalence of depression and anxiety is high in both chronic obstructive pulmonary disease (8-80% depression; 6-74% anxiety) and chronic heart failure (10-60% depression; 11-45% anxiety). However, methodological weaknesses and the use of a wide range of diagnostic tools make it difficult to reach a consensus on rates of prevalence. Co-morbid depression and anxiety are associated with increased mortality and healthcare utilisation and impact upon functional disability and quality of life. Despite these negative consequences, the identification and management of co-morbid depression and anxiety in these two diseases is inadequate. There is some evidence for the positive role of pulmonary/cardiac rehabilitation and psychotherapy in the management of co-morbid depression and anxiety, however, this is insufficient to guide recommendations.


CONCLUSIONS
The high prevalence and associated increase in morbidity and mortality justifies future research regarding the management of anxiety and depression in both chronic heart failure and chronic obstructive pulmonary disease. Current evidence suggests that multi-faceted interventions such as pulmonary and cardiac rehabilitation may offer the best hope for improving outcomes for depression and anxiety.
Yohannes
A M
AM
Department of Health Professions, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, UK. a.yohannes@mmu.ac.uk
Willgoss
T G
TG
Baldwin
R C
RC
Connolly
M J
MJ
D001007:Anxiety / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D002908:Chronic Disease; D015897:Comorbidity; D003866:Depressive Disorder / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D006333:Heart Failure / Q000523:psychology* / Q000534:rehabilitation; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data; D009520:New Zealand / Q000453:epidemiology; D015995:Prevalence; D011613:Psychotherapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology* / Q000534:rehabilitation; D011788:Quality of Life