“Psychological distress is not routinely examined in heart disease patients, and we believe that it should be, given the low percentage of patients who receive treatment from a mental health professional,” said Amy Ferketich, Ph.D., an epidemiology professor in the OSU School of Public Health.

Ferketich and Dr. Philip Binkley, a cardiologist and researcher in the Davis Heart and Lung Research Institute at Ohio State, studied data from the 2002 National Health Interview Survey (NHIS). The results of their study were published today in the European Heart Journal.

In the survey, psychological distress was reported by patients who had suffered from congestive heart failure (CHF), heart attack (myocardial infarction) and coronary heart disease (CHD). The survey measured psychological distress by asking patients to identify symptoms such as “so sad that nothing could cheer you up,” nervousness, restlessness and hopelessness.

In the U.S. population over age 40 and with no heart disease, the prevalence of psychological distress is 2.8 percent. Ferketich and Binkley found evidence of psychological distress in 4.1 percent of the CHD patients, 6.4 percent of the heart attack patients and 10 percent in the CHF patients. However, only 30 to 35 percent of the heart disease patients with psychological distress visited a mental health professional.

The size of this study alone makes these results notable, said Binkley. The NHIS survey contacted 36,787 individuals and received an overall response rate of nearly 75 percent, which is an excellent response rate for population-based surveys, according to Ferketich. The data included complete psychological information on more than 17,000 individuals age 40 and over.

“This study is the largest population-based examination of the prevalence of depression in patients with heart disease. It establishes that depression is an important factor that may contribute further to disease progression and diminished quality of life in these patients,” said Binkley.

Another significant feature of this research is the population studied, according to Ferketich. Other surveys have examined the burden of psychological distress in patients with heart disease, but those studies have used either hospital samples or outpatient volunteer samples. Those patients are often not representative of the entire population of patients with heart disease.

Generalized to the U.S. population, the results suggest that more than 1 million heart disease patients suffer psychological distress but most receive no treatment for it.

Clearly, individuals with heart disease are suffering from higher than normal levels of psychological distress. Previous studies have demonstrated that psychological distress causes more severe heart disease and greater mortality from the disease.

“This study tells us that we as clinicians must be sensitive to the presence of depression in our patients,” Binkley said.

Ferketich and Binkley recommend that clinicians make screening for psychological distress a routine part of treating a patient with heart disease.