Somatic Versus Cognitive Symptoms of Depression as Predictors of All-Cause Mortality and Health Status in Chronic Heart Failure

Objective: Depression is a predictor of adverse health outcomes in chronic heart failure (CHF), but it is not known whether specific symptoms drive this relationship. We examined the impact of somatic/affective, cognitive/affective, and total depressive symptoms on all-cause mortality and health status in CHF.

Method: Consecutive CHF outpatients (n=366) completed the Beck Depression Inventory. The primary endpoint was all-cause mortality; the secondary endpoint was disease-specific health status, as measured by the Minnesota Living with Heart Failure Questionnaire (n=285) at inclusion and 1-year follow-up. The study was conducted between October 2003 and March 2007.

Results: There were 68 (18.6%) deaths (mean±SD follow-up, 37.2±10.6 months). Patients high on somatic/affective depressive symptoms had a greater incidence of mortality compared to patients low on somatic/affective depressive symptoms (31% vs 15%; hazard ratio [HR]=2.3; 95% CI, 1.38–3.69; P=.001). There was no significant difference in the incidence of mortality between patients high versus low on cognitive/affective depressive symptoms (23% vs 18%; HR=1.4; 95% CI, 0.80–2.40; P=.25), but there was a significant difference between patients high versus low on total depressive symptoms (24% vs 16%; HR=1.6; 95% CI, 1.01–2.63; P<.05). After adjusting for demographic and clinical characteristics, we found that somatic/affective depressive symptoms predicted all-cause mortality (HR=1.8; 95% CI, 1.03–3.07; P=.04), while cognitive/affective and total depressive symptoms did not. Both dimensions of depressive symptoms predicted disease-specific health status at 1 year.

Conclusions: Only somatic/affective depressive symptoms significantly predicted all-cause mortality in CHF. In the context of diagnosing and intervening, awareness of subtypes of depressive symptoms is important.

Submitted: August 11, 2008; accepted November 4, 2008.

Online ahead of print: July 28, 2009.

Corresponding author: Angélique A. Schiffer, PhD, Department of Medical Psychology, TweeSteden Hospital, PO Box 90107, 5000 LA, Tilburg, the Netherlands (

J Clin Psychiatry 2009;70(12):1667-1673