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"Major" Depressive Disorder, Coronary Heart Disease, and the DSM–IV Threshold Problem

Received August 21, 2004; revised December 29, 2004; accepted March 7, 2005. From the Heart and Vascular Institute, Henry Ford Hospital & Wayne State University; and Consultation/Liaison Psychiatry, University of Cincinnati. Address correspondence and reprint requests to Dr. Ketterer, Henry Ford Hospital/CFP6, 2799 West Grand Blvd., Detroit MI 48202. e-mail: MarkWKetterer{at}cs.com

Seventy-seven patients with documented coronary heart disease (CHD) were evaluated for demographic/risk factor characteristics, Major Depressive Disorder (MDD) according to the Patient’s Health Questionnaire (PHQ – Diagnostic and Statistical Manual IV criteria), and emotional distress by the Symptom Checklist 90–Revised (SCL-90-R). Early age at initial diagnosis for coronary heart disease (AAID) was used as a proxy for disease malignancy because early AAID is a known predictor of early mortality. MDD was unrelated to early AAID despite being strongly associated with all the scales of the SCL-90-R. Several of the SCL-90-R scales were significantly associated with early AAID in the sample as a whole (Depression, Interpersonal Sensitivity, Anxiety, Paranoia, and Psychoticism) and after removal of the patients meeting criteria for MDD (residual N=54). Our results suggest a new criterion for determining whether depression, or any mental disorder, is "major": onset or aggravation of serious medical illness.

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