One year cumulative incidence of depression following myocardial infarction and impact on cardiac outcome

doi:10.1016/S0022-3999(03)00380-5

Journal of Psychosomatic Research

Volume 56, Issue 1, January 2004, Pages 59-66

https://doi.org/10.1016/S0022-3999(03)00380-5 Get rights and content

Abstract

Background

Major depression has been identified as an independent risk factor for increased morbidity and mortality in mixed patients populations with first and recurrent myocardial infarction (MI). The aim of this study was to evaluate whether incidence of major and minor depression is as high in a population with merely first-MI patients as in recurrent MI populations. Furthermore, it was evaluated whether in first-MI patients major and minor depression, and depressive symptoms, had an impact on cardiac mortality and morbidity up to 3 years post MI.

Methods

A consecutive cohort of 206 patients with a first MI were included in this study. One month following MI, all patients were interviewed using the Structured Clinical Interview for DSM-IV (SCID-I-R). Three, six, nine and twelve months following MI, patients filled out three psychiatric self-rating scales for depression, the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the 90-item Symptom Checklist (SCL-90). Patients, exceeding a previously defined cut-off value on at least one of these scales, were reinterviewed using the SCID. The BDI was applied to assess depressive symptoms in relation to cardiac outcome as the SCL-90 and HADS showed similar results. Cardiac outcome was defined as major cardiac event, i.e., death or recurrent MI, and health care consumption, i.e., cardiac rehospitalisation and/or frequent visits at the cardiac outpatient clinic. Depression outcome was assessed from 1 month post MI up to 1 year post MI whereas cardiac outcome was assessed between 1 month and 3 years post MI.

Results

A 1-year incidence of 31% of major and minor depression was found in first-MI patients. The highest incidence rate for both major and minor depression was found in the first month after MI. Compared with nondepressed patients, depressed patients were younger (P=.001), female (P=.04) and were known with a previous depressive episode (P=.002). Neither major/minor depression nor depressive symptoms significantly predicted major cardiac events, but did predict health care consumption (P=.04 and P<.001, respectively).

Conclusions

Incidence of major and minor depression is similar in this first-MI patients population as in recurrent MI populations. Major/minor depressive disorder nor depressive symptoms predicted neither mortality nor reinfarction.

Introduction

The incidence of depression increases after MI. Incidence estimates have varied largely from 15% to 30% for major depression and another 20% for minor depression or depressive symptoms [1]. This wide range can, at least in part, be explained by differences in patient populations, i.e., first- vs. recurrent-MI patients, study design, and diagnostic criteria [2], [3].

Major depression, but also minor depression and depressive symptoms have been identified as independent risk factors for cardiac mortality in hospitalized patients with MI in most [4], [5], [6], [7], but not all, studies [8], [9]. In one study with MI patients, major depression and depressive symptoms predicted cardiac mortality until 12 months; only the depressive symptoms predicted mortality also until 18 months [10]. In a community-based longitudinal study, the excess cardiac mortality risk was more than twice as high for major depression as for minor depression in subjects with and without cardiac disease at baseline [11]. Studies reporting an increased risk for cardiac mortality found also an increased risk for morbidity, an important indicator for quality of life and health care consumption [4], [5], [6], [7], [12].

In the abovementioned studies, depression rates were assessed in patient populations with both first and recurrent MI. The aim of this study was to evaluate prospectively the cumulative 1-year incidence of major and minor depression in a consecutive cohort of patients following a first MI. Secondly, we evaluated whether in this patient population major and minor depression, and depressive symptoms, predicted cardiac mortality and morbidity up to 3 years post MI.

Section snippets

Patients

Patients with a diagnosis of first MI were eligible for the present study. The patients were recruited from the Emergency Aid of the Department of Cardiology of the University Hospital of Maastricht, the Netherlands. This hospital serves both as a local catchment area and a university hospital, as it is the only hospital in the vicinity of Maastricht, serving approximately 180,000 habitants.

MI diagnoses were made by a cardiologist according to the following criteria: clinical picture and

Analysis

Cumulative incidence rates were analysed using survival analysis techniques. Missing values concerning depressive status during follow up were filled up as follows. A score “not depressed” was given, if the patient was not depressed at the time of the former assessment and the depressive status at the next screening was validly measured. In all other situations, the case was excluded from further analysis from the time point of the missing value onwards.

To rule out that depressed patients may

Patients

Two-hundred and six MI patients were included into the study, out of a total of 422 consecutive patients. Ninety-six MI patients were excluded (22.7%), while 99 eligible patients refused participation (23.5%) and an additional 21 (5%) only filled in the questionnaires but refused to attend the interview. Reasons for exclusion of the 96 patients were logistic problems (living too far, moving to another city, foreign language, n=45), death within the first month post MI (n=28), severe comorbidity

Discussion

In our study, we choose to include only patients following first MI as these patients were regarded as healthy prior to their MI and normally functioning. In patients with recurrent MI, non-MI-specific factors may play an important role in the relationship between depression and MI. Nonspecific depressogenic factors, such as disability or handicap leading to reduced professional and social activities, are related to chronicity of a disease, irrespective of its origins. These nonspecific factors

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Clinical outcomes in coronary disease in patients with diabetes or hypothyroidism are poor despite improvements in medications and interventions. The findings in depression are similar to those reported by Strik et al. [28], who states that major and minor depression predict an increased use of health care services, either for rehospitalization (OR 1.98; CI 95%, 1.0–3.93; p = 0.04) or for outpatient services (OR 3.75; CI 95%, 1.86–7.58; p < 0.001) without being able to predict death or reinfarction. This study did not find that depression in patients during hospitalization and at 3 months is a differential predictor of cardiovascular mortality compared with patients without depression.
Cardiovascular diseases are a public health concern worldwide, with high rates of morbidity and mortality. Depression is a frequent comorbidity in coronary heart disease (CHD). It can be caused by the experience of suffering from heart disease, but it can also influence the prognosis of the CHD. The prevalence of depression in patients with cardiovascular disease is twice as high as that in the general population.
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A total of 110 patients were enrolled with an average age of 57 ± 8.1 years. Sex ratio was 3.78. The incidences of depressive symptomatology at T0 and T1 were respectively 19.1% and 6.2%. Mean and cumulative incidences of depressive symptomatology were respectively 12.7% and 25.5%. According to the univariate analysis, drinking alcohol, overweight and anxiety were associated with the incidence of depressive symptomatology after SCA at T0. In binary logistic regression, drinking alcohol was the independent predictor of the incidence of depression after ACS at T0 with an odds ratio of 4.680 and CI of 95% [1.449; 15,107]; P = 0.01. In univariate analysis, drinking alcohol, high risk of hospital mortality, according to the GRACE score, and non performing coronary angiography were statistically associated with the overall incidence of depressive symptomatology.
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Citation Excerpt :
However, MACE before the 1 year follow-up point was not excluded, possibly exaggerating effects of early-phase depression. The other study, which evaluated 1-year cumulative incidence of major and minor depressive disorder, found no associations with cardiac mortality or recurrent MI up to 3 years post-ACS (Strik et al., 2004). However, a meta-analysis of 16 studies of depression following ACS found that differences in MACE occurrence became more prominent over longer follow-up intervals (Meijer et al., 2013), thus possibly accounting for our positive findings over a longer period.
Depression has been associated with worse cardiac outcomes in patients with acute coronary syndrome, while no study has investigated trajectory of depression and ACS prognosis. This study investigated associations of depressive disorder within 2 weeks (early) and at 1 year (late) after ACS with major adverse cardiac event (MACE).
In 757 ACS patients recruited in 2007–2012 and evaluated for depressive disorder at the two time-points, 5–12 year follow-up for MACE was conducted.
MACE incidence was significantly higher in patients with depressive disorder at early or late phase of ACS than those without, regardless of status at the other time point; however, highest incidence was found following depression at both time points.
The follow-up for depressive disorder was made at only one point.
Depression evaluation thus needs consideration both early and late post-ACS.

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One year cumulative incidence of depression following myocardial infarction and impact on cardiac outcome

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Patients

Analysis

Patients

Discussion

Psychosomatics

Prog Neuropsychopharmacol Biol Psychiatry

Am J Cardiol

J Psychosom Res

J Psychosom Res

The relationship of depression to cardiovascular disease

Arch Gen Psychiatry

Depression and 18 months prognosis after myocardial infarction

Circulation

Depression following myocardial infarction: impact on 6-months survival

JAMA

Affective disorders and survival after acute myocardial infarction (results from the post-infarction late potential study)

Eur Heart J

Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety

Psychosom Med

Depression and anxiety as predictors of outcome after myocardial infarction

Psychosom Med

Major depression before and after myocardial infarction: its nature and consequences

Psychosom Med

Depression and cardiac mortality: results from a community-based longitudinal study

Arch Gen Psychiatry

Structured clinical interview for DSM-IV Axis I disorders-patient edition (SCID-I/P, Version 2.0)

Diagnostic and statistic manual of mental disorders IV

An inventory for measuring depression

Arch Gen Psychiatry

On the validity of the Beck Depression Inventory

Psychopathology