Effect of Depression on Five-Year Mortality After an Acute Coronary Syndrome

Grace, Sherry L.; Abbey, Susan; Kapral, Moira K.; Fang, Jiming; Nolan, Robert P.; Stewart, Donna E.

doi:10.1016/j.amjcard.2005.06.052

Cited by 138 publications

(111 citation statements)

References 27 publications

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“…These results arise from direct visualization of the coronary vessels and support findings from one previous study which has shown more severe CAD in the incident depression subtype although only at trend level (Freedland, 1992). Even though the sample size in the present study was modest, the prevalence of the two depression types is comparable to that in other studies (Grace et al, 2005;de Jonge et al, 2006). The significant difference in CAD severity adds to mounting evidence that two …”

supporting

confidence: 78%

“…Grace and colleagues studied 750 post-ACS patients and found that 5 year mortality was highest among patients with incident depressive symptoms (as assessed by self-report) at time of hospitalization, and lowest in patients with a history of depressive symptomatology and no increased co-morbid depressive symptoms (Grace et al, 2005 It is not known why co-morbid depressive symptoms and / or co-morbid MDD in post-ACS patients are associated with recurrent cardiovascular events and mortality. One explanation is that worse cardiovascular outcome in this population is due to more severe coronary artery disease (CAD).…”

Section: Nih Public Accessmentioning

confidence: 99%

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Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients

Goodman

Shimbo

Haas

et al. 2008

Journal of Psychiatric Research

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There is recent evidence that acute coronary syndrome (ACS) patients with first time incident major depressive disorder (MDD) and those with recurrent MDD represent different subtypes among individuals with ACS and comorbid depression. However, few studies have examined whether or not these subtypes differ in coronary artery disease (CAD) severity. We assessed whether those with incident MDD (in-hospital MDD and negative for history of MDD) or recurrent MDD (in-hospital MDD and a positive history of MDD) differ in angiographically documented CAD severity. Within 1 week of admission for ACS, 88 patients completed a clinical interview to assess current and past diagnosis of MDD. CAD severity was assessed in all patients by coronary angiography. A hierarchical regression analysis showed that neither in-hospital MDD status, nor history of MDD were significant predictors of CAD severity, but the interaction term between in-hospital MDD status and history of MDD was a significant predictor of CAD severity, after controlling for age, sex and ethnicity. Follow-up analyses showed that patients with first-time, incident MDD had significantly more severe CAD compared to patients with recurrent MDD (p = 0.043). To conclude, our study adds to the growing evidence that patients with incident MDD should be considered as a clinically distinct subtype from those with recurrent MDD. Possible mechanisms for differing CAD severity by angiogram between these two subtypes are proposed and implications for prognosis and treatment are discussed. KeywordsAcute Coronary Syndrome; Coronary Artery Disease; Myocardial Infarction; Angiogram; Incident Major Depressive Disorder; Recurrent Major Depressive Disorder Extensive research has shown that comorbid major depressive disorder (MDD) after an acute coronary syndrome (ACS) event is an independent prognostic marker of increased morbidity and mortality (Barth et al., 2004;van Melle et al., 2004 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Thombs et al., 2006), and of these MDD patients, 50% or more have had depression symptoms in the past. Recent evidence suggests that patients who experience depression after ACS for the first time (incident depression) may represent a clinically distinct subtype when compared with depressed ACS patients who have had depressive symptoms in the past (recurrent depression). NIH Public AccessThe literature indicates that the extent to which comorbid MDD after ACS impacts future medical prognosis might be dependent on whether patients experience incident or recurrent depression. However, the evidence is mixed ...

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supporting

confidence: 78%

Section: Nih Public Accessmentioning

confidence: 99%

Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients

Goodman

Shimbo

Haas

et al. 2008

Journal of Psychiatric Research

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“…Previous studies have found inconsistent associations between SES and depression following ACS. Low education has been a significant predictor of depression in some studies (Grace et al 2005 ;Parashar et al 2006 ;Rutledge et al 2006 ;Frasure-Smith et al 2007 ;Carney et al 2009) but not others (Frasure-Smith et al 1993 ;Strik et al 2004 ;Martens et al 2008). Other markers of SES have been used less frequently, but Grace et al (2005) reported that patients with lower family incomes were more likely to have elevated BDI scores in hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Low education has been a significant predictor of depression in some studies (Grace et al 2005 ;Parashar et al 2006 ;Rutledge et al 2006 ;Frasure-Smith et al 2007 ;Carney et al 2009) but not others (Frasure-Smith et al 1993 ;Strik et al 2004 ;Martens et al 2008). Other markers of SES have been used less frequently, but Grace et al (2005) reported that patients with lower family incomes were more likely to have elevated BDI scores in hospital. It should be emphasized that the lowest income category in the present study (<£20 000 per annum) was well above the poverty line in the UK (around £6000 and £10 400 per annum for single and married individuals, respectively, at the time of the study), so patients in this category cannot be considered to have been in poverty.…”

Section: Discussionmentioning

confidence: 99%

Emotional triggering and low socio-economic status as determinants of depression following acute coronary syndrome

et al. 2011

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Background. The determinants of depression following acute coronary syndrome (ACS) are poorly understood. Triggering of ACS by emotional stress and low socio-economic status (SES) are predictors of adverse outcomes. We therefore investigated whether emotional triggering and low SES predict depression and anxiety following ACS.Method. This prospective observational clinical cohort study involved 298 patients with clinically verified ACS. Emotional stress was assessed for the 2 h before symptom onset and compared with the equivalent period 24 h earlier using case-crossover methods. SES was defined by household income and education. Depression was measured with the Beck Depression Inventory and the Hamilton Rating Scale for Depression and anxiety with the Hospital Anxiety and Depression Scale 3 weeks after ACS and again at 6 and 12 months. Age, gender, ethnicity, marital status, the Global Registry of Acute Coronary Events risk score, duration of hospital stay and history of depression were included as covariates.Results. Emotional stress during the 2-h hazard period was associated with increased risk of ACS (odds ratio 1.88, 95 % confidence interval 1.01-3.61). Both low income and emotional triggering predicted depression and anxiety at 3 weeks and 6/12 months independently of covariates. The two factors interacted, with the greatest depression and anxiety in lower income patients who experienced acute emotional stress. Education was not related to depression. Conclusions.Patients who experience acute emotional stress during their ACS and are lower SES as defined by current affluence and access to resources are particularly vulnerable to subsequent depression and anxiety.

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“…There is also the suggestion that somatic symptoms may be cardiotoxic, whereas cognitive-affective symptoms are not (de Jonge, van den Brink, Spijkerman, & Ormel, 2006). Incident depression post-ACS has been shown to be related to more severe CAD (Goodman, Shimbo, Haas, Davidson, & Rieckmann, in press;Spijkerman, de Jonge, et al, 2005), and is more cardiotoxic than other depression subtypes (de Jonge et al, 2006;Grace, Abbey, et al, 2005). This suggests that somatic symptoms such as fatigue may be markers of underlying disease severity or prodromal states.…”

Section: Future Directionsmentioning

confidence: 99%

Challenges in reducing depression-related mortality in cardiac populations: cognition, emotion, fatigue or personality?

Doyle

Conroy

McGee

2007

Health Psychology Review

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Effect of Depression on Five-Year Mortality After an Acute Coronary Syndrome

Cited by 138 publications

References 27 publications

Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients

Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients

Emotional triggering and low socio-economic status as determinants of depression following acute coronary syndrome

Challenges in reducing depression-related mortality in cardiac populations: cognition, emotion, fatigue or personality?

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