title: Severity of Depressive Symptoms Pre- and Postcardiac Rehabilitation: A COMPARISON AMONG PATIENTS IN BRAZIL, CANADA, COLOMBIA, THE UNITED STATES, AND VENEZUELA.
abstract: OBJECTIVE
  Depression is 3 times more prevalent in the cardiac than the general population in high-income countries and is particularly high in middle-income countries. Comorbid depression is associated with twice the mortality after a cardiovascular event. The objectives of this study were to describe and compare depressive symptoms pre- and postcardiac rehabilitation (CR) among patients in high-income countries and middle-income countries in the Americas.
  
  
  METHODS
  The study design was prospective and observational. A convenience sample of CR participants completed the Patient Health Questionnaire-9 (PHQ-9) at CR intake and again at program discharge. Clinical data were extracted from medical charts.
  
  
  RESULTS
  There were 779 participants: 45 Brazilian (5.8% of sample), 214 Canadian (27.5%), 126 Colombian (16.2%), 309 American (39.7%), and 85 Venezuelan (10.9%). Pre-CR depressive symptoms significantly differed between countries (P < .05), with Colombian participants reporting higher scores than Canadians and Venezuelans. Total PHQ-9 scores significantly decreased during CR in Colombia (mean change =-2.33; P < .001), the United States (mean change =-1.12; P < .001), and Venezuela (mean change =-2.14; P < .001), but not in Brazil (where less psychosocial intervention was offered) or Canada (where pre-CR scores were low). Among the 102 (13.1%) participants with scores in the elevated range pre-CR, the mean change in PHQ-9 scores was -6.57 ± 1.09 and 40 (39.2%) participants no longer had elevated symptoms postprogram.
  
  
  CONCLUSIONS
  Depressive symptoms are variable among patients with CR in South and North American countries. CR programs incorporating psychosocial components can reduce these symptoms.
authors.affiliation: Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Canada (Drs Ghisi and Grace); Cardiac Rehabilitation and Prevention Program, Mediagnóstica, Duitama, Colombia (Dr Santos); Division of Cardiovascular Diseases, Cardiac Rehabilitation and Secondary Prevention (ASCARDIO), Barquisimeto, Venezuela (Dr Benaim and Ms Rojas); Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota (Drs Lopez-Jimenez and Inojosa); Cardiology Institute of Santa Catarina, Regional Hospital of Sao Jose, São José, Brazil (Drs Herdy and Janovik); Department of Physical Medicine and Rehabilitation, Cardiovascular Rehabilitation Program, Mayo Clinic, Rochester, Minnesota (Dr Terzic); and School of Kinesiology and Health Science, York University, Toronto, Canada (Dr Grace).
authors.forename: Gabriela Lima de Melo
authors.initials: GLM
authors.lastname: Ghisi
authors.forename: Claudia Victoria Anchique
authors.initials: CVA
authors.lastname: Santos
authors.forename: Briseida
authors.initials: B
authors.lastname: Benaim
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
authors.forename: Artur Haddad
authors.initials: AH
authors.lastname: Herdy
authors.forename: Jose Medina
authors.initials: JM
authors.lastname: Inojosa
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Terzic
authors.forename: Lisiane
authors.initials: L
authors.lastname: Janovik
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Rojas
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D000072038:Cardiac Rehabilitation / Q000523:psychology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology; D003105:Colombia / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014687:Venezuela / Q000453:epidemiology