Background:

Screening for depression is vital in Cardiac Rehabiliation (CR) programs, but other signs of psychological distress are also important. The Herridge Cardiopulmonary Questionnaire (HCQ) was developed as a psychosocial screening instrument that assesses psychological constructs applicable to CR populations. The purpose of this study was to assess the utility and validity of the HCQ by correlating psychological constructs of the HCQ to the Beck Depression Inventory-II (BDI-II) and the mental component summary score (MCS) of the SF-36.

Methods:

Patients entering CR between 8/05 and 3/06 (n = 88; 27% women, 27% non-white, mean age 63+/-11 years) completed the Beck Depression Inventory (BDI-II), the Short-Form 36 (SF-36), and the HCQ. The proportion of patients with depressive symptoms (BDI-II) or general psychological distress (HCQ and MCS) were compared. Psychological constructs derived from the HCQ, BDI-II, and SF36 were correlated.

Results:

Depressive symptoms were noted on the BDI-II (BDI >= 14) in 22% of patients (mean BDI-II score 23.2 +/- 8.7). Significant levels of psychological distress were found in 35% of patients using the HCQ Total Score (HCQ >= 35) (mean score 46.4 +/- 10.4). Furthermore, 41% had a SF-36 MCS below the population mean (<=50; mean 36.8 +/- 8.0). All measures of psychological functioning were highly correlated: BDI-II and HCQ (r = .782), BDI and MCS (r = -.716) and HCQ and MCS (r = -.649), all P < .001. The BDI-II and the MCS of the SF-36 were significantly correlated with the psychological constructs measured by the HCQ, including depression (r = .724 and -.635), anxiety (r = .791 and -.640), stress (r = .679 and -.641), and hostility (r = .331 and -.321), all P < .001, respectively. Motivation (r = -.419, P < .001) and self-efficacy (r = -.264, P < .005) were also significantly negatively correlated with depression as measured by the BDI-II.

Conclusions:

Depression and other psychological risk factors such as anxiety, hostility, and stress are common in the CR population and could adversely impact how an individual copes with heart disease. The HCQ appears to be a suitable psychological screening instrument in the CR population, but more psychometric evaluation is needed to help identify psychological factors that may affect a patient's overall functioning.