Stressful Life Events, Depression and Demoralization as Risk Factors for Acute Coronary Heart Disease

Abstract

Background: While the effect of psychological stress and depression on the course of heart disease is commonly recognized, the relationship between recent life events, major depression, depressive symptomatology and the onset of acute coronary heart disease (CHD) has been less considered. The aim of this study was to investigate the presence of stressful life events, major and minor depression, recurrent depression and demoralization in the year preceding the occurrence of a first acute myocardial infarction (AMI) and/or a first episode of instable angina and to compare stressful life events, also related with mood disorders, in patients and healthy controls. Methods: 97 consecutive patients with a first episode of CHD (91 with AMI and 6 with instable angina) and 97 healthy subjects matched for sociodemographic variables were included. All patients were interviewed with Paykel’s Interview for Recent Life Events, a semistructured interview for determining the psychiatric diagnosis of mood disorders (DSM-IV), a semistructured interview for demoralization (DCPR). Patients were assessed while on remission from the acute phase. The time period considered was the year preceding the first episode of CHD and the year before the interview for controls. Results: Patients with acute CHD reported significantly more life events than control subjects (p < 0.001). All categories of events (except entrance events) were significantly more frequent. 30% of patients were identified as suffering from a major depressive disorder; 9% of patients were suffering from minor depression, 20% from demoralization. Even though there was an overlap between major depression and demoralization (12%), 17% of patients with major depression were not classified as demoralized and 7% of patients with demoralization did not satisfy the criteria for major depression. Independently of mood disorders, patients had a higher (p < 0.001) mean number of life events than controls. With regard to life events, the same significant difference (p < 0.001) compared to controls applied to patients with and without mood disorders. Conclusions: Our findings emphasize, by means of reliable methodology, the relationship between life events and AMI. These data, together with those regarding traditional cardiac risk factors, may have clinical and prognostic implications to be verified in longitudinal studies.

Distress, demoralization and psychopathology: Diagnostic boundaries

“…The problem of diagnosis of demoralization is complicated, partly because of the need for a clear distinction between distress and SI, partly because demoralization appears to be a process and not a static and immutable entity, and partly because demoralization may coexist with mental disorders as well as physical illnesses. For example, demoralization has been documented in primary care patients 45,46 , and in patients with coronary artery disease 50 , motor neuron disease 51 , functional gastrointestinal disorders 52,53 , breast cancer 54,55 , and gastrointestinal and colorectal cancer 19,45,46 . Hopelessness was significantly associated with an increased risk of cardiovascular disorders and cancer [56][57][58][59][60] , predicted the length of survival in patients with coronary artery disease 61 and the progression of carotid atherosclerosis 62 .…”

The association between critical life events, sociodemographic data and physical activity in the development of myocardial infarction in smokers and ex-smokers

“…Rafanelli et al [11] investigated the relationship between stressful life events (e.g. employment, financial status, family and social problems) and acute myocardial infarction as part of their study.…”

“…Owing to the retrospective nature of the study and the pathophysiological process of myocardial infarction (potentially extending over many years), it could not be ascertained whether stressful life events alone are related to the onset of illness or its clinical manifestations [11].…”

“…Psychosocial dimensions should therefore also play an important role in myocardial infarction prevention and treatment alongside the necessary medical procedures [11]. Although in most cases the occurrence of critical life events cannot be prevented, it can be assumed that each person perceives and processes these relatively unwanted experiences differently.…”

Diagnosticando e tratando depressão no paciente com doença clínica

“…Serão necessárias novas pesquisas no sentido de melhor avaliar quais as implicações e a importância do conceito de desmoralização para a prática clínica. Sua importância como fator de risco para depressão (Shader, 2005), na evolução e no prognóstico de doenças somáticas não-psiquiátricas (Rafanelli et al, 2005) deverá ser confirmada em estudos longitudinais.…”