前言：充血性心臟衰竭病患是造成老年人殘疾、住院和死亡的重要原因，其人數也持續增加中。充血性心臟衰竭病患合併出現憂鬱的情形相當的常見。充血性心臟衰竭病患合併出現憂鬱也增加了對於疾病預後有害的一些因素，包括增加死亡的危險性、提高再住院率、降低生活品質與增加醫療費用的負擔。目的：本文的目的主要在於探討充血性心臟衰竭病患合併出現重度憂鬱症的盛行率和形成的相關因素，也探討充血性心臟衰竭病患的基本特性與憂鬱症狀的關聯性。方法：在此橫斷面的調查中，研究對象為從中山醫學大學附設醫院心臟科門診篩選出無明顯認知障礙、臨床穩定且能走動的充血性心臟衰竭病患，這些病患均屬於紐約心臟聯盟(NYHA)分類的第二級或第三級嚴重度病情。以簡明版世界衛生組織生活品質問卷(WHOLOQ-BREF)評估患者的生活品質，以漢氏憂鬱量表(HAM-D)測量憂鬱的嚴重度，採用迷你國際神經精神會談工具(Mini International Neuropsychiatric Interview: MINI)作為結構性的面談以篩選出病患有否合併重度憂鬱症。結果：合計75位充血性心臟衰竭病患完成調查，屬紐約心臟聯盟(NYHA)分類的第二級嚴重度病情有62名，第三級嚴重度病情有13名，平均年齡為65.3±10.7歲，病患合併出現重度憂鬱症的盛行率為4%(n=3)。經由分析性統計顯示：充血性心臟衰竭病患合併出現重度憂鬱症者較未合併重度憂鬱症者缺乏社會支持。充血性心臟衰竭病患的基本特性與憂鬱症狀的關聯性方面，顯示憂鬱症狀嚴重度與紐約心臟聯盟分類的第三級嚴重度病情、虛弱症狀有顯著性的相關。結論：充血性心臟衰竭病患合併出現重度憂鬱症的情形仍不能忽略，充血性心臟衰竭病患缺乏社會支持較容易合併產生重度憂鬱症。以上的發現能對於臨床人員治療充血性心臟衰竭病患提供一些重要的參考。
Purpose: There is increasing number of patients with congestive heart failure(CHF) which is the major cause of disability, hospitalization, and mortality in the elderly. Depression is a relatively common condition among individuals with CHF. CHF with depression also had additional risks of adverse outcomes, including increased mortality, a higher rehospitalization rate, decreased quality of life and higher costs of care. This study investigated prevalence of depression and related factors in CHF patients and explored associations between symptoms of depression and subjects’ baseline characteristics. Methods: In this cross-sectional survey, 75 clinically stable, ambulatory CHF patients were consecutively recruited from outpatient cardiology clinics at Chung Shan Medical University Hospital. We used the World Health Organization Quality Of Life-BREF (WHOQOL-BREF) to examine quality of life profiles and the Hamilton Rating Scale for Depression (HAM-D) to screen patients for depression. Patients with high HAM-D scores(≧12) were interviewed by psychiatrists who used the Mini international Neuropsychiatric Interview (MINI) to diagnose major depressive disorder(MDD). Results: Of 75 subjects who completed the study, average age was 65.3±10.7 years. Based on New York Heart Association (NYHA) criteria, patients were class II (82.7%, n=62) or class III (17.3%, n=13). MDD prevalence was 4% (n=3). Bivariate analysis among subjects with (n=3) and without MDD (n=72) indicated that patients with MDD were more likely to lack social support (p=0.02). Higher HAM-D scores were significantly associated with NYHA class III (p=0.015) and weakness (p=0.000). Conclusions: Treatment of CHF patients needs to address the fact that depression is a common clinically important illness in CHF patients. Although our findings need to be replicated, they indicate that MDD were significantly more likely in CHF patients who lacked social support
