Depressive symptoms and perceived doctor-patient communication in the Heart and Soul study

Abstract

Background: Doctor-patient communication is an important marker of health-care quality. Little is known about the extent to which medical comorbidities, disease severity and depressive symptoms influence perceptions of doctor-patient communication in patients with chronic disease.

Methods: In a cross-sectional study of 703 outpatients with chronic coronary disease, we evaluated the extent to which patient reports of doctor-patient communication were influenced by medical comorbidities, disease severity and depressive symptoms. We assessed patient reports of doctor-patient communication using the Explanations of Condition and Responsiveness to Patient Preferences subscales from the "Interpersonal Processes of Care" instrument. Poor doctor-patient communication was defined as a score of <4 (range 1 to 5) on either subscale. All patients completed the nine-item Patient Health Questionnaire (PHQ) for measurement of depressive symptoms and underwent an extensive evaluation of medical comorbidities and cardiac function.

Results: In univariate analyses, the following patient characteristics were associated with poor reported doctor-patient communication on one or both subscales: female sex, white or Asian race and depressive symptoms. After adjusting for demographic factors, medical comorbidities and disease severity, each standard deviation (5.4-point) increase in depressive symptom score was associated with a 50% greater odds of poor reported explanations of condition (OR 1.5, 95% CI, 1.2-1.8; p < 0.001) and a 30% greater odds of poor reported responsiveness to patient preferences (OR 1.3, 95% CI, 1.1-1.5; p = 0.01). In contrast, objective measures of disease severity (left ventricular ejection fraction, exercise capacity, inducible ischemia) and medical comorbidities (hypertension, diabetes, myocardial infarction) were not associated with reports of doctor-patient communication.

Conclusions: In outpatients with chronic coronary heart disease, depressive symptoms are associated with perceived deficits in doctor-patient communication, while medical comorbidities and disease severity are not. These findings suggest that patient reports of doctor-patient communication may partly reflect the psychological state of the patient.

Figure 1

Distribution of summary scores on the explanations of condition and responsiveness to patient preferences subscales*. *Participants rated doctor-patient communication on a five-point Likert scale ranging from “never” to “always”. A summary score was generated for each subscale by adding up the total scores within the scale and dividing by the number of answered questions. Higher scores indicate better experiences of communication.

Figure 2

Percentage of participants reporting poor communication on the explanations of condition and responsiveness to patient preferences subscales,* stratified by depressive symptom score †. *Subscale score < 4 = Poor Doctor-Patient Communication. † Depressive systems assessed using the 9-item Patient Health Questionaire (PHQ range of scores 0-27). PHQ score 0-3 = none-minimal; PHQ score 4-9 = mild; PHQ score ≥ 10 = moderate-severe.