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Prognostic Association of Depression Following Myocardial Infarction With Mortality and Cardiovascular Events: A Meta-analysis

van Melle, Joost P. MD; de Jonge, Peter PhD; Spijkerman, Titia A. MD; Tijssen, Jan G. P. PhD; Ormel, Johan PhD; van Veldhuisen, Dirk J. MD, PhD; van den Brink, Rob H. S. PhD; van den Berg, Maarten P. MD, PhD

Review Articles

Objective: To assess the association of depression following myocardial infarction (MI) and cardiovascular prognosis.

Methods: The authors performed a meta-analysis of references derived from MEDLINE, EMBASE, and PSYCINFO (1975–2003) combined with crossreferencing without language restrictions. The authors selected prospective studies that determined the association of depression with the cardiovascular outcome of MI patients, defined as mortality and cardiovascular events within 2 years from index MI. Depression had to be assessed within 3 months after MI using established psychiatric instruments. A quality assessment was performed.

Results: Twenty-two papers met the selection criteria. These studies described follow up (on average, 13.7 months) of 6367 MI patients (16 cohorts). Post-MI depression was significantly associated with all-cause mortality (odds ratio [OR], fixed 2.38; 95% confidence interval [CI], 1.76–3.22; p <.00001) and cardiac mortality (OR fixed, 2.59; 95% CI, 1.77–3.77; p <.00001). Depressive MI patients were also at risk for new cardiovascular events (OR random, 1.95; 95% CI, 1.33–2.85; p = .0006). Secondary analyses showed no significant effects of follow-up duration (0–6 months or longer) or assessment of depression (self-report questionnaire vs. interview). However, the year of data collection (before or after 1992) tended to influence the effect of depression on mortality (p = .08), with stronger associations found in the earlier studies (OR, 3.22; 95% CI, 2.14–4.86) compared with the later studies (OR, 2.01; 95% CI, 1.45–2.78).

Conclusions: Post-MI depression is associated with a 2- to 2.5-fold increased risk of impaired cardiovascular outcome. The association of depression with cardiac mortality or all-cause mortality was more pronounced in the older studies (OR, 3.22 before 1992) than in the more recent studies (OR, 2.01 after 1992).

CI = confidence interval; CA = cardiac arrest; CABG = coronary artery bypass graft; CAD = coronary artery disease; DIS = modified version of the National Institute of Mental Health Diagnostic Interview Schedule; DM = diabetes mellitus; DSM = Diagnostic and Statistical Manual of Mental Disorders; DISH = Depression Interview and Structured Hamilton; ENRICHD = Enhancing Recovery in Coronary Heart Disease Patients Randomized Trial; FU = follow up; HADS = hospital anxiety and depression scale; IHD = ischemic heart disease; KSb-S = Klinische Selbstbeurteilungsskalen aus dem Münchner psychiatrische Informations-System; LVEF = left ventricular ejection fraction; MADRS = Montgomery Asberg Depression Rating Scale; MI = myocardial infarction; MIND-IT = Myocardial INfarction and Depression–Intervention Trial; NA = not available; OR = odds ratio; PVC = premature ventricular contraction; SCID = Structured Clinical Interview for DSM; SCL-90 = 90-item Symptom Check List; SSRI = selective serotonin re-uptake inhibitor.

From the Department of Cardiology, Thoraxcenter (J.P.v.M., D.J.v.V., M.P.v.d.B.), and the Department of Psychiatry (P.d.J., T.A.S., J.O., R.H.S.v.d.B.), University Hospital Groningen, Groningen, The Netherlands; and the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (J.G.P.T.).

Address correspondence and reprint requests to Joost P. van Melle, MD, research fellow, Cardiology, Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB, The Netherlands. E-mail: j.p.van.melle@thorax.azg.nl

Received for publication February 6, 2004; revision received August 11, 2004.

Prof. Van Veldhuisen is Established Clinical Investigator of the Netherlands Heart Foundation (D97.017). Dr. Van Melle and Dr. de Jonge are supported by a grant of the Netherlands Heart Foundation (97.016).

Copyright © 2004 by American Psychosomatic Society
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