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Self-reported depressive symptoms, diagnosed clinical depression and cardiac morbidity and mortality after myocardial infarction.

Abstract：

BACKGROUND:Self-reported depressive symptoms and clinical depression after myocardial infarction (MI) are both associated with poor cardiac prognosis. It is important to distinguish between the two when assessing cardiac prognosis, but few studies have done so. The present article evaluates the independent prognostic impact of self-reported depressive symptoms and clinical depression on cardiac outcomes after MI. METHODS:2704 MI-patients were administered the Beck Depression Inventory (BDI) and underwent the Composite International Diagnostic Interview at 3 months post-MI. All-cause mortality, cardiac mortality and cardiovascular readmissions were evaluated up till 10 years post-MI (mean: 6 years), representing 16,783 persons-years of follow-up. Event-free survival was evaluated using Cox regression analysis. RESULTS:Analyses on mortality and cardiovascular readmissions included 2493 and 2434 patients respectively. Compared to patients scoring <5 on the BDI, those scoring ≥ 19 had age- and sex-adjusted HR's (95% CI) of 3.20 (2.16-4.74, p<0.001) for all-cause mortality, 3.97 (2.06-7.65, p<0.001) for cardiac mortality, and 1.45 (1.08-1.95, p<0.05) for cardiovascular readmissions. Cardiac disease severity and cardiac risk factors explained one third to half of the relationship. The presence of clinical depression was associated with all-cause (HR: 1.72 (1.29-2.30, p<0.001)) and cardiac mortality (HR: 1.67 (1.01-2.77, p<0.05)). However, adjusting for BDI-scores decreased these HR's with 53% and 72% respectively, rendering them non-significant. Dichotomized BDI-scores remained to predict cardiac prognosis independently from the presence of clinical depression. CONCLUSIONS:After MI, self-reported depressive symptoms are a more accurate predictor of cardiac morbidity and mortality than clinical depression. This association is confounded largely by cardiac disease severity.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Zuidersma M,Conradi HJ,van Melle JP,Ormel J,de Jonge P

doi

10.1016/j.ijcard.2012.07.002

subject

Has Abstract

pub_date

2013-09-10 00:00:00

pages

2775-80

issue

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(12)00939-4

journal_volume

167

pub_type

杂志文章,多中心研究,随机对照试验

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Self-reported depressive symptoms, diagnosed clinical depression and cardiac morbidity and mortality after myocardial infarction.