There had been numerous studies and data gathering done to correlate depression and cardiovascular disease. While the exact pathophysiology that produces depression particularly for cardiovascular disease patients is yet to be established, researchers are almost certain that 1 in every 5 patients with a heart condition is experiencing a depressive state . In the website of Depression and Bipolar Support Alliance it was mentioned that 20 to 30% of patients who suffered from stroke have suffered from a major depressive disorder . Similarly, the website also indicated that at least 1 in every 3 patients who suffered a heart attack is depressed . Another alarming findings indicated by researchers from the National Institute for Mental Health have suggested that people with depression are most like to suffer a heart attack, and is most likely to be at risk for another heart attack or increase the risk of death. While the statistics grow and gets updated each year, it is imperative that the studies relating to depression and cardiovascular disease should be continuously improved and diversified if only to prevent the risk of these statistics contributing to the already growing mortality rate of cardiovascular patients.
In lieu with this, the author of this paper would like to establish the level and degree by which patients with cardiovascular disease who are also suffering from depression are most likely to have prevailing thoughts about death and debilitation. The goal is to try and understand the degree of depression that patients of CVD have in relation to their existing medical condition. It is the hope of this paper that by doing so, the number of patients with CVD who are committing suicide because of hopelessness be significantly reduced. This has been triggered by the insights that 2/3 of the 30,000 documented suicide are due to depression.
Objective of the Study
Considering the statistics and the results of studies that correlates depression and cardiovascular disease, it is the purpose of this study to know the severity of depression that patients of the given medical condition experienced and enumerate the reasons that cause it. In this regard, the incidence of depression among CVD patient will not result to death.
Statement of the problem
What is the demographic profile of patients with CVD and depression in terms of:
Does patients with CVD and are suffering from depression have prevailing thoughts about death and debilitation?
If yes, how prevalent or persistent are these thoughts?
What could have triggered the thoughts from developing?
How does CVD patients with depression act out their depression when it happens?
What could trigger depression for CVD patients (risk factors)?
Have this thoughts ever reached a point of self-mutilation or suicide?
Hypothesis is defined as “a tentative guess or assumption used to describe or explain a phenomenon” . Hypothesis follows sequential assumptions that offers the closest explanation to a given condition, which opens room for validation through observation and experimentation. For this study entitled Depression and Cardiovascular Disorder: Tendencies and Manifestations the proponent assumed the following hypotheses:
H1σ: A specific demographic profile of an individual with CVD does not create a unified impact on tendencies and manifestations of depression.
H1α: A specific demographic profile of an individual with CVD creates a unified impact on tendencies and manifestations of depression.
H2σ: An individual with CVD who had been stroke does not have more serious, life-threatening tendencies and manifestations of depression.
H2α: An individual with CVD who had been stroke have more serious, life-threatening tendencies and manifestations of depression.
H3σ: An individual with CVD who have had experience a heart attack does not have more serious, life-threatening tendencies and manifestations of depression.
H3α: An individual with CVD who have had experience a heart attack have more serious, life-threatening tendencies and manifestations of depression.
Conceptual Framework for the Study
The purpose of the conceptual framework is to enumerate the variables that were to be utilized for the study. In addition, it will also discuss the flow of the study to give the readers the idea of what to expect from the study conducted. For this study, the proponent decided to us the IPO model or the input-process-output model. This model is utilized to help determine the cause and effect by naming the process that generated the output
Figure 1: Conceptual Framework for the Study
In the case of the study, the output represents the dependent variable which is the result to the study. For this study, the result is identifying the tendencies and manifestations of depression among CVD patients. The independent variable on the other hand, refers to the input or the causes that could trigger the said result. Process is the approach utilized to generate the result for the study. In this study, the process included survey and interview.
Significance of the Study
The intention of this study is to understand what could significantly cause the life threatening tendencies and manifestations of depression. The study is initiated to target and address the following sector of the population:
Patients with Cardiovascular Disease.
Cardiovascular disease is the leading cause of death in the United States accounting to 30.4% of the total 2,596,993 deaths in 2013 . This translates to 789,485 deaths alone. The proponent would like to establish whether the following indicates that the deaths could be self-inflicted as a result of the individual’s depression. This study would help patient’s manage their depression and find a more effective outlet of their emotions to prevent any life-threatening manifestations of depression that typically comes with the diagnosis of CVD or instances of the associated risk factors relating to CVD like stroke and previous heart attack.
Family of CVD Patients
This study aims to benefit the family members of patients with CVD especially those who are at risk of falling into depression. This paper aims to help these people in caring for their family member who might be experiencing the symptoms and who are at risk of committing a life-threatening manifestation of depression. This would serve as their guide in assessing a severely depress individual.
Medical Health Care Professional
This paper would benefit medical health care professionals in caring for CVD patients who are experiencing depression. This paper can serve as an additional reference in the process of creating a patient’s care plan. It emphasized the need to incorporate into the care plan teachings relating to depression and preventive measures to ensure patients with CVD do not fall into depression.
This paper is designed to help future researchers to have additional resource for their study. Furthermore, the insights from this study can be utilized for future study or additional topic for research. However, this paper is not ambitious to state that will provide absolute answers nor could the findings drawn from this study can be held as a general result across all gender, race, age, etc.
Review of Related Review
This chapter holds relevant articles, studies and documents that discuss the topic of depression and cardiovascular diseases from the last 10 years prior to the conduct of this study. This is inclusive of dates from 2005 to 2015.
Academic Researches on Depression and Cardiovascular Diseases
Perhaps the very moving quote that can be associated to depression and cardiovascular diseases is one delivered by William Harvey, an English physician whose specialization extends to systemic circulation. According to Harvey,
For every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart.
According to Harvey, the brain houses the hypothalamus allowing the brain to understand the concept of pain and pleasure. He further that since the heart and the brain are connected the information processed by the brain as painful and fearful is translated into the heart, thereby affecting the brain through the development of cardiovascular diseases . In 1993, a study initiated by Frasure-Smith and associates concluded that depression can be fatal for people suffering with CVD. This argument was establishment after an experiment showed that depression is fatal for patients with myocardial infraction who have undergone the knife compared to patients who does not experience depression . However, despite the significant findings that related depression and CVD, depression remains to be ignored. In fact, cardiac care in majority of hospitals worldwide fail to incorporate depression as one of the most important adverse reaction and risk factor for CVD . Similar findings were noted in a recent study which supports that depression should also be a part of cardiac care for patients who are suffering from CVD especially those who are identified as high risk patients, meaning they have had stroke or suffered heart attack .
In 2006, an article featured at the Journal for American Medical Association emphasized that “major depressive disorder and cardiovascular disease are the 2 leading causes of worldwide disability1 and among the top 5 chronic disorders encountered in the care of older patients” (Whooley, 2006, p.2875). Also in the same study, the author said the the possibility of recurrent cardiac event if highly possile if patient was experiencing depression. The author’s findings revealed that depression causes palpitation which prevents the heart from relaxing thereby risking the patient for a heart attack. Suls and Bundle (2005) however found that coronary heart disease is developed in patients who have showed three prevalent affective disposition—(a) depression, (b) anxiety and (c) anger-hostility.
Overall, the result of numerous studies done on the subject of depression and cardiovascular disease all contributes to unified conclusion. These studies proved that while there had been numerous evidence that connects cradiovascula diseas with depression, no actual solution has been offered to prevent CVD patients from falling into depression. Numerous studies had all been unanimous in suggesting that once a patient is diagnosed with CVD, depression should also be assessed. Regardless of findings, depression should always be a part of the cardiac care plan of the patients.
Chapter 3 of this academic research is designed to address the methodological framework of the study. It will present a discussion on the design and procedures used by the proponent to arrive at a reliable and valid conclusion. This would include the identification of research design and justification of why this format is the most appropriate design to be used for this study. In addition, the proponent will also identify the respondents and the locale selected. This will establish the relevance of the study in the academe and in the field of Psychology. Finally, this chapter will also contain the tools used by the author like survey questionnaires and statistical procedure to help facilitate the study.
The study is designed to determine how patients with cardiovascular disease develop life-threatening tendencies and manifestations of depression. Given the nature of the study, the descriptive method of research is the most suitable design to determine the factors that affects the development of such behavioral patterns.
Descriptive researches are envisioned at determining the position of the variables with a specific condition in a designation and preselected population. This is completed without any attempt to control the cause and the effect of circumstance to the population . This type of research methodology offers useful information concerning the views of the population as well as producing hypotheses based on the data collected. To be more precise, this study will employ the use of triangulation as a research methodology. The proponent of this study would conduct a methodological triangulation which utilized different methodological approach to establish the objectives formulated for this study. Triangulation frequently incorporates the use of both qualitative and quantitative technique in one research study. For this study, the quantitative aspect will be formed by a survey participated by 110 different respondents. On the other hand, the qualitative part of this study shall be a collaboration of the extensive literature review done across all period. The purpose of using this technique—a triangulation methodology was to attain at a consistently reliable conclusion that will incorporate the empirical data produced from the literature review with the results of the survey and case study analysis.
For this study the proponent conduct the research in several local hospitals with a Cardiology In-patient Department. The target of this study involved patients diagnosed with cardiovascular disease who were high risk, for depression. This is the easiest way to gather as much respondents as possible that would qualify to the criteria set for this study.
The proponent of this study decided to use the purposive sampling as a sampling technique to determine the participants in the study. Purposive Sampling permits that the participants of a study are preselected and anyone who were deemed not fitting of the criteria will automatically be excluded from the . This type of sampling technique is utilized specifically to address a specific purpose.
The proponent of this research decided to conduct a quantitative and qualitative study to approach the subject of life-threatening tendencies of depression in correlation to having cardiovascular disease. For the quantitative aspect of the research, the proponent would perform a survey participated by 120 participants. The respondents will be composed of men and women of diverse age, educational background and employment. The study would be imploring the use of a self-constructed survey questionnaire that follows the Likert Scale format designed with a 5 point-rating scale. The rating scale’s verbal interpretation is presented in Table 1. The self-constructed questionnaire is made up of two (2) part. The first part is the demographic profile section which will attempt to classify the respondents based on their gender, age, educational background, employment status and marital status. The second part will be made up of fifteen (15) questions which is designed to understand the behavior and perspective of patients.
For the qualitative part of the study, the literature review will be composed of extensive academic researches, studies and articles written about depression and cardiovascular disease. The materials were to be written and published from the last 10 years, inclusive years 2005-2015 for the purpose of relevance and accuracy of details and information. However, exceptions are applied for statistical records which is generated for the purpose of comparison.
For this research the proponent will use two different processes. The first process addresses the extensive literature review. For this part of the study, the proponent shall gather all the policies from 2005 to 2015 (present) which refers to depression and cardiovascular diseases. Similar studies conducted in different countries will also be used to establish a trend.
For the survey, the proponent shall request through purposive random sampling the participation of one hundred twenty participants. All participants are diagnosed with cardiovascular disease and are classified as high risk for depression as determined by the parameters set forth by Elderona and Whooley’s study (2013) and Depression and Bipolar Support Alliance. The respondents will be requested to respond to the self-constructed survey questionnaire. Upon completion of all questionnaires had been filled out and tallied, the proponent shall perform statistical analysis of the outcome to draw pertinent insights connected to the purpose of the study.
In interpreting the result of the survey, the proponent utilized simple comparative statistics using frequency, mean and percentage. These formulations were used only to establish a consensus. The following formula were used for this study:
Frequency – refers to the number of times the particular answer has been recorded over a specific period of time.
f=x1+ x2+ x3..+ xn
Mean – the sum of all the values divided by the total number of population
x= x1+ x2++ xnn
Percentage – the number of ratio express as a fraction of 100
%= xy ×100
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Elderona, L., & Whooley, M. (2013). Depression and Cardiovascular Disease. Progress in Cardiovascular Diseases, 56(6), 511–523.
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