title: Relevance of depression for anticoagulation management in a routine medical care setting: results from the ThrombEVAL study program.
abstract: BACKGROUND
  Depressive symptoms have detrimental effects on quality of life and mortality. Poor adherence to a treatment regimen is a potential mechanism for the increased risk of adverse medical events associated with depression. Regarding oral anticoagulation with vitamin K antagonists, adherence is crucial for the outcome. Little is known about the clinical relevance of current depressiveness for anticoagulation treatment.
  
  
  OBJECTIVE
  To examine the impact of current depressiveness on anticoagulation treatment in regular medical care.
  
  
  METHODS
  We examined the association between clinically significant depressiveness as assessed by the Patient Health Questionnaire-2 ≥ 2 (PHQ-2 ≥ 2) with the percentage of time in the therapeutic range (TTR), self-rated compliance, several aspects of health literacy, anticoagulation side-effects and treatment satisfaction in a cross-sectional study of 1790 oral anticoagulation outpatients.
  
  
  RESULTS
  Seven hundred and sixteen participants (40.0%) had clinically significant depressive symptoms. Depressed persons reported lower compliance with intake of prescribed medication and regular visits for control of anticoagulation, more unspecific side-effects (e.g. pruritus) and lower satisfaction with the anticoagulation treatment and their doctors' expertise and empathy. Depressed as compared with non-depressed individuals had a lower TTR (-4.67; 95% CI, -8.39 to -0.95). Increasing severity of depressiveness was related with decreasing TTR. However, depressiveness lost its significant impact on TTR after multivariable adjustment (-3.11; 95% CI, -6.88 to 0.66).
  
  
  CONCLUSIONS
  Clinically significant depressiveness was highly prevalent and impaired several aspects of anticoagulation treatment. Depressiveness should be regarded as a clinically significant condition that needs to be addressed in the management of anticoagulation patients.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Michal
authors.forename: J H
authors.initials: JH
authors.lastname: Prochaska
authors.forename: A
authors.initials: A
authors.lastname: Ullmann
authors.forename: K
authors.initials: K
authors.lastname: Keller
authors.forename: S
authors.initials: S
authors.lastname: Gobel
authors.forename: M
authors.initials: M
authors.lastname: Coldewey
authors.forename: T
authors.initials: T
authors.lastname: Münzel
authors.forename: J
authors.initials: J
authors.lastname: Wiltink
authors.forename: M E
authors.initials: ME
authors.lastname: Beutel
authors.forename: P S
authors.initials: PS
authors.lastname: Wild
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000553:Ambulatory Care; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D010644:Phenprocoumon / Q000008:administration & dosage; D015995:Prevalence; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010644:Phenprocoumon
keywords: ambulatory care; anticoagulants; depression; medication adherence; patient satisfaction; phenprocoumon