Comment on "Depression after CABG: A prospective study."

LETTERS TO THE EDITOR

Comment on "Depression after CABG: A prospective study."

Umit Cintosun, Umut Safer

Department of Geriatrics, Gulhane School of Medicine. Ankara, Turkey.

Dear Editor

In the December 2013 edition of the Brazilian Journal of Cardiovascular Surgery, Nunes et al.^[1] reported that a high prevalence of depressive symptoms in coronary artery bypass surgery (CABG) patients group, especially on the initial six months after surgery. Results of study by Nunes et al. are particularly important not only because depression is a mortality risk factor after CABG, but tapping a serious problem worldwide - the need of addressing the supply of physicians ^[2] . However, we disagree how the patients were classified as depressive.

There are some scales for screening depression and Beck Depression Inventory (BDI) is one of them. Current study consists of population of elderly subject which was almost half of entire study participants. In elderly, Geriatric Depression Scale is useful tool to assess the depression because of its brevity and favorable psychometric properties. However, BDI may not be suitable for screening depression in elderly people ^[3] .

Previous history of depression or other mood disorders were not reported in the current study. Previous studies showed that depression is a risk factor for cardiovascular diseases and the coronary events are 1.64 times higher in depressed patients^[4] . It is possible to conclude that depressive symptoms reported in the study by Nunes et al.^[1] may be present before CABG and not related to CABG. We believe that these point needs to be considered as arguable with regards in the present study.

References

1. Nunes JKVRS, Figueiredo Neto JA, Sousa RML, Costa VLXC, Silva FMAM, Hora AFLT, et al. Depression after CABG: a prospective study. Rev Bras Cir Cardiovasc. 2013;28(4):491-7.

2. Pinton FA, Carvalho CF, Miyazaki MCOS, Godoy MF. Depression as a risk factor for early and late morbidity after coronary artery bypass surgery. Rev Bras Cir Cardiovasc. 2006;21(1):68-74.

3. Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S454-66.

4. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med. 2004;66(6):802-13.