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Burden of Mental Depression in Patients with
Chronic Heath Failure: A Cross-Sectional Study in Cameroon’s Reference Hospitals
Jérôme Boombhi1,2*, Jean-Pierre Kamga1,3, Mazou N Temgoua1, Alain Menanga1,2, Liliane Mfeukeu-Kuaté1,4, Delphine Kingue3 and Samuel Kingué1,2
1Faculty of Medicine and Biomedicals Sciences, University of Yaoundé I, Cameroon
2Cardiology Unit, General Hospital Yaoundé, Cameroon
3 Psychiatric Unit, Jamot Hospital Yaoundé, Cameroon
4 Cardiology Unit, Central Hospital Yaoundé, Cameroon
Submission: September 20, 2019; Published: October 10, 2019
*Corresponding author: Jerome Boombhi, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
How to cite this article:Jérôme Boombhi, Jean-Pierre Kamga, Mazou N Temgoua, Alain Menanga, Liliane Mfeukeu-Kuaté etc all. Burden of Mental Depression in
Patients with Chronic Heath Failure: A Cross-Sectional Study in Cameroon’s Reference Hospitals. J Cardiol & Cardiovasc Ther. 2019; 15(2): 555906.
Background: Chronic Heath Failure (CHF) is a global public health problem. It is associated with psychological problem that have a great impact in Quality of life. Amongst the psychological disorders associated with CHF, mental depression is a major one. There are few studies done in Sub-Sahara Africa in general and specifically in Cameroon. The knowledge of the epidemiology of depression in Cameroon will help policymakers to reduce burden of CHF in this part of the world. The aim of this pilot study was to determine the prevalence of mental depression in patients with Chronic Heath Failure followed in three reference hospitals of Cameroon.
Methodology: We carried out a cross-sectional study over a period of 04 months, from January to May 2017. The patients were recruited from the cardiology departments of three references Hospitals of Cameroon: Yaoundé Central Hospital (YCH), General Hospital of Yaoundé (GHY) and Yaoundé University Teaching Hospital (YUTH). We included all patients aged 18 years and above followed for CHF and consenting to participate in the study. Patients with other chronic conditions (chronic kidney disease, cancer, schizophrenia) were excluded. Evaluation and detection of mental depression was done by the Patient Health Questionnaire 9 (PHQ-9).
Results: A total of 119 patients were recruited. The mean age was 66 ± 13 years. More than 2/3 (70.6%) of the patients were unemployed. The majority of patients (83.2%) had low monthly income (<100 000 FCFA). Stage II of heart failure according to New York Heart Association (NYHA) was the most represented (50%). The prevalence of depression was 35.3% (n=42) with the respective frequency of 26.1%, 8.4%, 0.8% for mild, moderate, moderately severe.
Conclusion: The prevalence of mental depression is high in patients with Chronic Heart Failure in Cameroon. The clinician should be aware of that in order to improve quality of life of these patients.
Abbreviations: CHF: Chronic Heart Failure; GHY: General Hospital of Yaoundé; HF: Heart Failure; IQR: Interquartile Range; LVEF: Left Ventricular Ejection Fraction; MD: Mental Depression; NYHA: New York Heart Association; PHQ-9: Patient Health Questionnaire 9; QOL: Quality of Life; SPSS: Statistical Package for Social Sciences; WHO: World Health Organization; YUTH: Yaoundé University Teaching Hospital
Chronic Heart Failure (CHF) is a major cause of death Worldwide . In the survivors it is associated with various complications interesting physical, social and psychological aspects that affected quality of life . The burden in Sub-Saharan
Africa is also high; in fact, Heart Failure (HF) accounts for over 30% of hospital admission in specialized cardiovascular units and 3% to 7 % in general internal medicine . Amongst the psychological complications, Mental Depression (MD) is well studied abroad. It is defined as disorder of a mood characterized by reduction of pleasure and desire in the daily activities due to disequilibrium of
a stable psychological condition for at least 2 weeks . In United
States, Gotlieb et al. , Friedmann et al. , Rohyans et al. 
found the respective prevalence of 48%, 36%, and 28%. In Europe
the reported prevalence was approximately the same with a range
of 28.6 to 30% [8,9]. In Asia this prevalence was also high with
a range of 24% to 68% depending of specific groups of patients
and site of the recruitment . Despite the high burden of the
disease and its known psychological impact, there are few studies
done in Sub-Sahara Africa. We therefore conducted this pilot work
in order to determine the prevalence of mental depression in
patients with Chronic Heath Failure followed in three reference
We carried out a cross-sectional study over a period of 04
months, from January to May 2017. The patients were recruited
from the cardiology departments of three references Hospitals
of Cameroon: Yaoundé Central Hospital (YCH), General Hospital
of Yaoundé (GHY) and Yaoundé University Teaching Hospital
(YUTH). We included all patients aged 18 years and above followed
for CHF and consenting to participate in the study. Patients
with other chronic conditions (chronic kidney disease, cancer,
schizophrenia) and those with incomplete file were excluded.
Sample size calculation was done by Cochrane formula 
N: minimal sample size
Z: 1.96 for an alpha error of 5%
P: 0.3 (Prevalence of heart failure in Cameroon found by
Kingue et al. .
Using a structured pilot-tested questionnaire, we briefly
interviewed all attended patients in external consultation unit of
cardiology department. We collected following socio-demographic
data: sex, age, matrimonial status, level of education, ethnic origin,
religion, profession, monthly income, and monthly cost of health
care and existence of medical insurance. Clinical data concerned:
Cardiovascular risk factors such as history of alcohol or tobacco
consumption, sedentary lifestyle, obesity defined as a body mass
index ≥30 kg/m2, dyslipidemia, hereditary exposure, duration
and etiologies of chronic health failure, weight, height, body mass
index. Severity of heart failure was assessed using the functional
class of New York Heart Association (NYHA). The Left Ventricular
Ejection Fraction (LVEF) was determining by transthoracic
cardiac ultrasonography by using either Teicholz or Simplify
Simpson’s formula. Therapeutic data concerned current drugs
for heart failure, side effect and compliance. The adherence to
treatment was evaluated by Gired questionnaire . Evaluation
and detection of mental depression was done by the Patient
Health Questionnaire 9 (PHQ-9). The PHQ-9 classified patients
into 5 categories according to their marks between the value 0 to
27: None depression (0 to 4) mild (5 to 9), moderate (10 to 14),
moderately severe (15 to 19) and severe (20 to 27) .
Data were analysed using SPSS version 23.0. Means (standard
deviations), medians, interquartile range (IQR) were used
to summarize continuous variables, while frequencies and
proportions were calculated for categorical variables.
A total of 119 patients were recruited with female
predominance (n=68; 58%). The mean age was 66 ± 13 years with
range of 20 to 94 years. More than 2/3 (70.6%) of the patients
were unemployed. The majority of patients (83.2%) had low
monthly income (<100 000 FCFA) (Table 1). Hypertension was
the major co-morbidity and Stage II of heart failure according to
New York Heart Association (NYHA) was the most represented
(50%). There were approximately the same proportions of all
type of heart failure according to the left ventricular ejection
fraction (Table 2).
Mental depression is a major syndrome found in various
chronic illnesses . This psychological disorder is frequently
associated with poor quality of life in patient with Chronic Heart
Failure . The prevalence of depression in CHF has been study
in developed countries and many strategies have been put in place
in order to reduce its burden [16-22]. In Low income countries
little is known about the distribution of this pathology amongst
patients with HF. One third of our patient were concerned with
various degree of severity this was similar to the previous studies
abroad; but it is important to precise that severe depression
was rare. The scarcity of severe form of mental depression is
probable due to the fact that patients were recruited in external
consultation and were more in stable conditions compare to
reported literature. Hwang et al.  reported a prevalence of
mental depression of 68% for hospitalized patients with CHF
compare to 24% for patients in external consultation . This
illustrates the fact that hospitalized patients are more exposed to
depression, probably because of many factors like: non controlled
disease cost of health care or environmental influence itself. Since
these patients already have mild to moderate form of depression in stable condition, they should require a lot of attention when
they are hospitalized. Considering the high number of patients
hospitalized in Cameroon for HF , the prevalence of mental
depression could be higher than that predicted by our results.
Mental depression is highly prevalent amongst patients with
Chronic Heart Failure in Cameroon. The clinicians should pay
attention of that in order to reduce morbidity and mortality of HF
in this context.
Ethics approval and consent to participate: Ethical
approval was obtained from the Institutional Review Board of
the Faculty of Medicine and Biomedical Sciences, University of
Yaoundé I. Also, administrative authorization was obtained from
the Directors of the General Hospital of Yaoundé, Central Hospital
of Yaoundé and Yaoundé University Teaching Center prior to the
start of the study. Written informed consent was obtained from all
study participants who part took in this study.
Availability of data and materials: The datasets used
and analyzed during the current study are available from the
corresponding author on reasonable request.
JB, TDKN, JPOK, and LMK, SK: study conception and design,
data collection and analysis, interpretation of results. Manuscript
writing and critical revision: JB, MNT. All the authors read and
approved the final version of the manuscript.
We would like to acknowledge the study participants for
their commitment. The authors equally thank the administrative
authorities of the Yaoundé General Hospital, Central Hospital of
Yaoundé and Yaoundé University Teaching Center for granting
them authorization to carry out this study.