Congestive heart failure (CHF) is the most common indication for hospitalization in adults over 65, and is a leading cause of medical morbidity, mortality, and reduced quality of life. Depression is a prevalent comorbid psychiatric condition in CHF patients. The goal of this project is to identify the adverse effects of depression in this population. The specific aims for Project Years 04-06 are to determine whether major depression: (1) increases the one-year mortality rate, and if so, to identify the subgroups at highest risk; (2) increases one-year medical morbidity and rehospitalization rates; and (3) impairs physical functioning and quality of life. A cohort of 432 CHF inpatients (50% female, 29% African-American, mean age 66.4 years), of whom 18% met the DSM-IV criteria for major depression at index, was recruited during the first phase of this project, and one-year follow-ups are still in progress. An additional 350 inpatients with confirmed CHF, for a combined sample of 782 patients, is needed to achieve the proposed aims. Depression will be diagnosed from a structured interview. CHF severity will be assessed by echocardiography, and lethal arrhythmias and other cardiac abnormalities will be assessed by electrocardiography. Functional status will be determined by a structured interview and the Six-Minute Walk Test. Other pertinent medical data will be obtained from medical records, and a standardized psychometric battery will be administered to assess the patient's psychological functioning, social support, and quality of life. Patients will be re-interviewed by telephone at 3-, 6-, 9-, and 12-month follow-ups to assess depression chronicity, physical and psychosocial functioning, and medical events. Medical records will also be obtained in order to document rehospitalizations and medical morbidity. Collateral interviews, hospital records, and death certificates will be obtained to ascertain mortality endpoints and to document cause of death.