oa Exploring Depression Amongst Cardiovascular Patients Living in the State of Qatar – Findings from a Cross-Sectional Study

Introduction

Cardiovascular diseases are the leading cause of death. Studies show that depression is associated with an increased morbidity and mortality among cardiovascular (CV) patients. Depression contributed to patients’ unfavorable prognosis after a cardiac event, hamper cardiac rehabilitation, and increase hospital re-admission rate among CV patients. Studies show that 15 – 30% of CV patients experience depression. Early detection and intervention for depression among cardiovascular patients can reduce morbidity and mortality rates. Understanding factors contribute to the risk of depression and its management among cardiovascular patients is necessary to adequately address the complex nature of depression as co-morbidity among Arab CV patients in the Middle East region. Objectives: (1) To evaluate the prevalence and severity of depression among patients who have confirmed diagnosis of cardiovascular diseases; and (2) To find ways to manage depression among male and female Arab CV patients. Methods: Using non-probability, convenient sampling method, a cross-sectional survey was conducted with 1000 Arab CV patients of which 688 (69%) male and 312 (31%) females between January, 2013 and September, 2014 at the Heart Hospital in Qatar. Inclusion criteria were ≥ 20 years of age, agreeing to participate in the study (98% response rate), and having final confirmation of acute cardiac conditions. Face-to-face interviews were conducted using structured survey questionnaires which included an Arabic demographic questionnaire and the Arabic version of the Beck Depression Inventory 2nd Edition (BDI-II) - a self-report instrument, which had been translated into Arabic and validated for its validity and reliability. Descriptive and inferential statistics were performed using SPSS version 20. Results: Almost half of the male and female participants were Qatari nationals (46%). Citizens of the Levant countries (Syria, Lebanon, Palestine, Jordan) constituted 20% and North African countries (Egypt, Libya, Tunisia, Algeria, Morocco) constituted 17% of the participants. 80% of the patients had no depressive symptoms, 15% of the patients had Mild Mood Disturbance and 5% had symptoms of clinical depression. Almost twice as many females (29%) than males (16%) were found to suffer from Mild Mood Disturbance and Clinical Depression. Approximately half of both male and female patients who scored ≥ 17 on the BDI-II (suggesting symptoms of clinical depression) refused psychiatric assistance. Chi Square tests indicated that age and socioeconomic factors, nationality, marital status, monthly income, employment, occupation, financial stress and support were significantly related to gender and depression (all p <  0.001).

Conclusion: (1) In-depth systematic assessment of mental health status and screening for depression should be performed routinely for all patients who had diagnosed with cardiovascular diseases, particularly females.

(2) Public awareness and education about mental health are critical in order to reduce the stigma associated with accessing treatment for it.

(3) Practices, treatments and diagnostic tools for depression should be thoroughly investigated and adapted to the Arab Middle Eastern context in order to facilitate the development of culturally appropriate mental health care and uptake of cardiac interventions and rehabilitation.

(4) Health policy makers should encourage and support psychiatric training and primary health care providers should be trained to provide psychiatric assistance to CV patients.

(5) Socioeconomic related factors influence the mental health of male and female CV patients differently and accordingly their CV conditions and outcomes.

(6) To effectively manage and treat depression among Arab CV patients, health care providers should be encourage to integrate gender differences approach into clinical practice.