title: Depressed or not depressed: untangling symptoms of depression in patients hospitalized with coronary heart disease.
abstract: BACKGROUND
  Assessing depression in patients hospitalized with coronary heart disease is clinically challenging because depressive symptoms are often confounded by poor somatic health.
  
  
  OBJECTIVE
  To identify symptom clusters associated with clinical depression in patients hospitalized with coronary heart disease.
  
  
  METHODS
  Secondary analyses of 3 similar data sets for hospitalized patients with coronary heart disease who had diagnostic screening for depression (99 depressed, 224 not depressed) were done. Depressive symptoms were assessed by using the Hamilton Depression Rating Scale or the Beck Depression Inventory. Hierarchical cluster analysis was performed on 11 symptom variables: anhedonia, dysphoria, loss of appetite, sleep disturbance, fatigue, guilt, suicidal symptoms, hypochondriasis, loss of libido, psychomotor impairment, and nervous irritability. Associations between symptom clusters and presence or absence of clinical depression were estimated by using logistic regression.
  
  
  RESULTS
  Fatigue (69%) and sleep disturbance (55%) were the most prevalent symptoms. Guilt (25%) and suicidal symptoms (9%) were the least common. Three symptom clusters (cognitive/affective, somatic/affective, and somatic) were identified. Compared with patients without cognitive/affective symptoms, patients with the cognitive/affective symptom cluster (anhedonia, dysphoria, guilt, suicidal symptoms, nervous irritability) had an odds ratio of 1.41 (P<.001; 95% CI, 1.223-1.631) for clinical depression.
  
  
  CONCLUSIONS
  Clinicians should be alert for clinical depression in hospitalized patients with coronary heart disease who have the cognitive/affective symptom cluster.
authors.affiliation: Anthony W. McGuire is an assistant professor, California State University, Long Beach, School of Nursing, Long Beach, California. Jo-Ann Eastwood and Aurelia Macabasco-O'Connell are assistant professors and Lynn V. Doering is professor and chair, Translational Sciences Section, University of California, Los Angeles, School of Nursing, Los Angeles, California. Ron D. Hays is a professor, Department of Medicine and Department of Health Services, School of Public Health, University of California, Los Angeles, and a senior behavioral scientist at RAND, Santa Monica, California.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: McGuire
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Eastwood
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Aurelia
authors.initials: A
authors.lastname: Macabasco-O'Connell
authors.forename: Lynn V
authors.initials: LV
authors.lastname: Doering
mesh_terms: D002986:Clinical Trials as Topic; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000523:psychology*; D003627:Data Interpretation, Statistical; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D013577:Syndrome