title: Depressive symptoms in outpatients with heart failure: importance of inflammatory biomarkers, disease severity and personality.
abstract: OBJECTIVE
  Depressive symptoms are highly prevalent in heart failure (HF) patients, however the underlying etiology of depression in HF patients remains yet unclear. Hence, the goal is to examine the relative importance of inflammation, disease severity and personality as predictors of depression in HF patients.
  
  
  METHODS
  Depressive symptoms (Hospital Anxiety and Depression Scale, depression subscale) were assessed at baseline and one-year follow-up in 268 HF patients (75.6% men; mean age = 66.7 ± 8.7). Markers of inflammation (TNFα, sTNFr1, sTNFr2, IL-6 and IL-10), disease severity (e.g. New York Heart Association (NYHA) classification) and personality (Type D personality, loneliness) were assessed at baseline.
  
  
  RESULTS
  At baseline, NYHA class, body mass index, educational level, Type D personality and loneliness were significantly associated with depression. Higher NYHA class (B = 2.25; SE = .83), higher educational level (B = 1.41; SE = .48), Type D personality (B = 2.56; SE = .60) and loneliness (B = .19; SE = .05) were also independently associated with higher depression levels at one-year follow-up (all p-values < .005). Inflammation, brain natriuretic peptide and left ventricular ejection fraction were not related to depression over time.
  
  
  CONCLUSIONS
  Personality factors, but not inflammation, were independent concomitants of depressive symptoms in patients with HF. Gaining more insight into the etiology of depression in HF patients is important in order to identify potential targets for novel interventions.
authors.affiliation: a Department of Medical Psychology and Clinical Psychology, CoRPS-Center of Center of Research on Psychology in Somatic Diseases , Tilburg University , Tilburg , The Netherlands.
authors.forename: Corline
authors.initials: C
authors.lastname: Brouwers
authors.forename: Nina
authors.initials: N
authors.lastname: Kupper
authors.forename: Aline J
authors.initials: AJ
authors.lastname: Pelle
authors.forename: Balász M
authors.initials: BM
authors.lastname: Szabó
authors.forename: Bert L W J J M
authors.initials: BL
authors.lastname: Westerhuis
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003863:Depression / Q000097:blood / Q000209:etiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D010551:Personality; D012720:Severity of Illness Index; D048069:Tumor Necrosis Factors / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D048069:Tumor Necrosis Factors; D016753:Interleukin-10