Cardiac Depression Scale: Mokken scaling in heart failure patients
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Cardiac Depression Scale: Mokken scaling in heart failure patients Chantal F Ski1, David R Thompson1*, David L Hare2, Andrew G Stewart2 and Roger Watson3
Abstract Background: There is a high prevalence of depression in patients with heart failure (HF) that is associated with worsening prognosis. The value of using a reliable and valid instrument to measure depression in this population is therefore essential. We validated the Cardiac Depression Scale (CDS) in heart failure patients using a model of ordinal unidimensional measurement known as Mokken scaling. Findings: We administered in face-to-face interviews the CDS to 603 patients with HF. Data were analysed using Mokken scale analysis. Items of the CDS formed a statistically significant unidimensional Mokken scale of low strength (H0.8). Conclusions: The CDS has a hierarchy of items which can be interpreted in terms of the increasingly serious effects of depression occurring as a result of HF. Identifying an appropriate instrument to measure depression in patients with HF allows for early identification and better medical management. Keywords: Cardiac Depression Scale, Heart failure, Depression, Mokken scaling
Background Heart failure (HF) is a leading cause of morbidity and mortality worldwide that imposes a considerable human and economic burden [1-4]. Depression and depressive symptoms are common in patients with HF though estimates of prevalence vary depending on method and timing of assessment [5,6]. A meta-analytic review on depression in HF reported clinically significant depression in 21.5% of patients, but varied by use of questionnaires versus diagnostic interview and HF severity [6]. Accurate identification of depression in patients with HF is critical because of significant associations with increased hospitalisations [5,7,8], poorer functional limitations [9,10], lower survival rates [8,11,12], and reduced quality of life [13]. Despite an American Heart Association (AHA) advisory recommending depression screening for all patients with coronary heart disease [14], depression remains under recognised and under treated in this population [15]. Given the potential health consequences of untreated comorbid HF and depression, the value of using reliable and valid * Correspondence: [email protected] 1 Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia Full list of author information is available at the end of the article
instruments to measure depression cannot be underestimated. This is paramount when one considers the numerous indirect costs of depression such as absenteeism, decreased productivity, increased risk for secondary complications, and malignant effects on dependent family members [16,17]. Recognition of depression in patients with HF is complicated by an overlap in risk factors such as smoking, excessive alcohol consumption, obesity, and lower physical activity, and symptoms such as fatigue, lack of interest in activities, appetite gain or loss, psychomotor impairment, po
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