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Original Research

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

Angélique A. Schiffer, PhD; Aline J. Pelle, MSc; Otto R. F. Smith, MSc; Jos W. Widdershoven, MD, PhD; Eric H. Hendriks, MANP; and Susanne S. Pedersen, PhD

Published: July 28, 2009

Article Abstract

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 (

Volume: 70

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