Healing Depression is Key to a Healthy Heart

Sidney Hankerson, MD, MBAColumbia University, College of Physicians and Surgeons

New York State Psychiatric Institute

New York Life Symposium: Heart-2-HeartThe City College of New York

May 2, 2012

Sabrina’s Story• Sabrina is a married, 43 year old mother of two

children. Since she lost her job 4 months ago, she is having trouble sleeping, is eating constantly with a 12 pound weight gain, can’t concentrate, feels guilty about losing income for her family, and gets no pleasure out of playing with her children. She has withdrawn from friends and her husband has threatened to leave if something does not change. She recently started using cocaine to deal with her stress, but begins to notice pain in her chest. As she begins to cry quietly, Sabrina tells you that she “wishes she could go to sleep and not wakeup.”

What Does “Depression” Mean to You?

Clinical Depression• 2 week period of depressed or irritable mood or lack of

interest or pleasure in activities– Sleep problems– Guilt / Worthless– Energy decrease (Fatigue)– Concentration decrease / Difficulty making decisions– Appetite disturbance (Increase or Decrease)– Abnormal movements (Restlessness or Slowed down)– Suicidal ideation / Thoughts of death

American Psychiatric Association. Diagnostic and Statistic Manual IV-TR. 2001.

Leading Causes of Worldwide Disability by 2020

Murray CJ, Lopez AD. Lancet. 1997;349(9064):1498-504.

Rank Disease or Injury

1 Cardiovascular Disease

2 Major Depression3 Road-traffic accidents

4 Cerebrovascular disease

5 COPD

6 Lower respiratory infections

7 Tuberculosis

8 War injuries

9 Diarrheal diseases

10 HIV

Risk Factors for Depression

• Women• Young age• Low income• Single or previously married • Family history

Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095-105.

Risk Factors for Heart Disease

• African American• High blood pressure• Depression and anxiety• Diabetes• Obesity• High cholesterol• Substance use

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004449/

Depression and Medical Disorders

• Depression impacts medical disorders– Cardiovascular disease– High blood pressure– Obesity– Diabetes – HIV /AIDS

DiMatteo MR et al. Arch Intern Med. 2000;160(14):2101-7.

American Heart Association. Heart Disease and Stroke Statistics-2009 Update. Circulation 2009.

Keitner GI et al. American Journal of Psychiatry 1991.

Depression is Destroying the Black Community

• Depression in African Americans, in comparison to Whites, is…– More severe– More disabling– More persistent– More resistant to

treatment

Williams DR, Gonzalez HM, Neighbors H, et al. Arch Gen Psychiatry. Mar 2007;64(3):305-315.

Depression is Under-treated in African Americans

• Factors that contribute to lower levels of care– Stigma– Distrust of providers– Less access to care

Forbes RO. “Depression: A Health Disparity in Minority Populations” 2005.

Stressors of Urban Life

Artinian NT, Washington OGM, Flack JM, Hockman EM, Jen K-LC. Depression, Stress, and Blood Pressure in Urban African-American Women. Progress in Cardiovascular Nursing. 2006;21(2):68-75.

Vicious Cycle of Poor Health

Stress

Depression

Heart Disease High Blood Pressure Obesity

Adapted from Artinian NT, Washington OGM, Flack JM, Hockman EM, Jen K-LC. Depression, Stress, and Blood Pressure in Urban African-American Women. Progress in Cardiovascular Nursing. 2006;21(2):68-75.

Church-Based Depression Care can be an Answer

• African Americans’ preferences – Spirituality (i.e., prayer) is extremely important– Counseling over medications

• Church-based care increases access– Working with ministerial staff builds trust– Stigma is reduced

Cooper LA, Brown C, Vu HT, Ford DE, Powe NR. J Gen Intern Med. Sep 2001;16(9):634-638.

Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB. J Gen Intern Med. Aug 2000;15(8):527-534.

Key Points

• Depression is a devastating illness • Depression and heart health are inseparable• There are safe, effective treatments for

depression• Community-based efforts can overcome

stigma to get people care• “Our goal is to create a beloved community…”

Dr. Martin Luther King, Jr.

Contact Information

• Sidney Hankerson, MD, MBA– Email: hankerss@nyspi.columbia.edu– Office: 212-543-6148– Address: 1051 Riverside Drive Unit 24 New York, NY 10032