Cardiologists, other doctors and long term care staff might be missing the big picture as one survey suggests that only a third of heart disease patients with serious symptoms of depression or anxiety get any treatment. The findings are significant because psychological problems have been linked to poorer health and higher death rates in heart disease patients. Unfortunately, long term care residents and other heart patients just aren't being screened because physicians are just focused on the heart disease and don't think about other factors that could contribute to the condition.

We know that heart attack survivors suffer from psychological distress twice as much as the general population and, with congestive heart failure patients, who are often residing in nursing homes, the figure is twice that?Staggering! However, only about one third of heart disease patients who report the symptoms are ever treated by a mental-health provider. This is appalling because research suggests that psychological problems often contribute to the onset of heart disease and worsen its progression.

It's not entirely clear how psychological distress and heart disease are connected. However, there is some speculation that psychological symptoms may contribute to blood clots or make the heart beat less efficiently. Since the overwhelming amount of long term care residents are women, it's important for staff to note that women with mild and moderate depression are 50 percent more likely to have heart attacks than are other women.

It's also crucial to note that depression and anxiety are frequent responses to traumatic events, such as the life-threatening and chronically debilitating illnesses, which are often seen in long term care settings. The seriousness of these symptoms is usually proportional to their duration and depth and the degree to which they compromise the resident's life quality and/or participation in the treatment process.

Triggers for referral for a psychological evaluation include symptoms that have continued for more than two weeks or significantly impair functioning, life quality or participation in prescribed treatment programs.

The role of heart doctors in detecting psychological problems in their patients who are long term care residents is a big problem. They often don't have time because of the new emphasis on quick turnaround and high productivity. That places the onus squarely on the long term care staff who see the resident every day.

One remedial protocol to identify the residents who really need help might be for nurses and other staff members to help screen residents before they meet with their cardiologists. Neglecting identification and treatment of psychological symptoms in residents with heart disease is very unfortunate because doctors now have effective tools to treat psychological problems, which might lead to a lessening of both the psychological distress and cardiac dysfunction.

Copyright 2005, M. Shery http://www.nursinghomes.md/

Dr. Michael Shery is the founder of Long Term Care Specialists in Psychology, a mental health firm specializing in consulting to the long term care industry. Its website, http://www.NursingHomes.MD provides state-of-the-art mental health treatment, facility staffing and career information to long term care professionals. To get a copy of the special report, "How to Reduce Resident Agitation Using Strength-Embedded Counseling," email: drmike@nursinghomes.md and put "Special Report" in the subject field.

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