Five-Year Risk of Cardiac Mortality in Relation to Initial Severity and One-Year Changes in Depression Symptoms After Myocardial Infarction

Abstract

Background-Although previous research demonstrated an independent link between depression symptoms and cardiac mortality after myocardial infarction (MI), depression was assessed only once, and a dose-response relationship was not evaluated. Methods and Results-We administered the Beck Depression Inventory to 896 post-MI patients during admission and at 1 year. Five-year survival was ascertained using Medicare data. We observed a significant long-term dose-response relationship between depression symptoms during hospitalization and cardiac mortality. Results remained significant after control for multiple measures of cardiac disease severity. Although 1-year scores were also linked to cardiac mortality, most of that impact was explained by baseline scores. Improvement in depression symptoms was associated with less cardiac mortality only for patients with mild depression. Patients with higher initial scores had worse long-term prognosis regardless of symptom changes. Conclusions-The level of depression symptoms during admission for MI is more closely linked to long-term survival than the level at 1 year, particularly in patients with moderate to severe levels of depression, suggesting that the presumed cardiovascular mechanisms linking depression to cardiac mortality may be more or less permanent for them.

Postmyocardial Infarction Mortality in Relation to Depression: A Systematic Critical Review

“…In 10 of the 20 studies of medium quality, a positive relation was reported [1, 2, 8,14,15,16, 19, 20, 24, 25; ]Appendix 1], whereas in the remaining ten studies a non-significant relation was reported [3, 6, 10, 12, 18, 22,27,28,29,30]; Appendix 1]. In 2 of the 4 studies of low quality, a positive relation was reported [9, 11]; Appendix 1], whereas the other two failed to report on this relation [4, 7]; Appendix 1].…”

“…In 5 of the 9 studies, where the BDI was applied, a positive relation was reported [1, 8, 14, 15, 26; ]Appendix 1], whereas a non-significant relation was reported in three studies [18, 27, 30; ]Appendix 1], and the sixth and last study [7]; Appendix 1] failed to report on this. Fifteen studies applied other questionnaires than the BDI.…”

“…For the twelve studies with data collection starting after 1994, a positive relation was reported in three studies [[16, 24, 26]; Appendix 1], and a non-significant relation was reported in the remaining nine studies [12, 13, 17, 18, 22, 23, 27, 29, 30; ]Appendix 1]. The studies with data collection starting after 1994 were generally of a better methodological quality, with four studies being of good quality [13, 17, 23, 26; ]Appendix 1], of which three reported a non-significant relation between depression and post-MI mortality, and the remaining eight studies were of medium quality [12, 16, 18, 22, 24, 27, 29, 30; ]Appendix 1[,] than those with data collection starting before 1994, with two studies being of good quality [5, 21; ]Appendix 1], eleven being of medium quality [1,2,3, 6, 8, 10, 14, 15, 19, 20, 25; ]Appendix 1], and four studies being of low quality [4, 7, 9, 11; ]Appendix 1].…”

“…Articles that fitted these criteria were given an identification number [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31] Appendix 1]. They were then systematically reviewed for descriptive information for quality issues.…”

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“…As individuals recover from depressive episodes, their mortality risk decreases. However, the effect may be strongest among those with preexisting cardiovascular disease (Lé sperance et al, 2002).…”