One year cumulative incidence of depression following myocardial infarction and impact on cardiac outcome
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
References (36)
- et al.
Sensitivity and specificity of observer and self rating questionnaires in depression following myocardial infarction
Psychosomatics
(2001) - et al.
Depression and myocardial infarction: Relationship between heart and mind
Prog Neuropsychopharmacol Biol Psychiatry
(2001) - et al.
Biobehavioral variables and mortality on cardiac arrest in the cardiac arrhythmia pilot study (CAPS)
Am J Cardiol
(1990) Factors which provoke post-infarction depression. Results from the post-infarction late potential study
J Psychosom Res
(1992)International experiences with the hospital anxiety and depression rating scale: a review of validation data and clinical results
J Psychosom Res
(1997)- et al.
The relationship of depression to cardiovascular disease
Arch Gen Psychiatry
(1998) - et al.
Depression and 18 months prognosis after myocardial infarction
Circulation
(1995) - et al.
Depression following myocardial infarction: impact on 6-months survival
JAMA
(1993) - et al.
Affective disorders and survival after acute myocardial infarction (results from the post-infarction late potential study)
Eur Heart J
(1991) - et al.
Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety
Psychosom Med
(2001)
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
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2020, Journal of Affective DisordersCitation 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.