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Systematic Review and Individual Patient Data Meta-Analysis of Sex Differences in Depression and Prognosis in Persons With Myocardial Infarction: A MINDMAPS Study

Doyle, Frank PhD; McGee, Hannah PhD; Conroy, Ronán DSc; Conradi, Henk Jan PhD; Meijer, Anna MSc; Steeds, Richard MD; Sato, Hiroshi PhD; Stewart, Donna E. MD; Parakh, Kapil PhD; Carney, Robert PhD; Freedland, Kenneth PhD; Anselmino, Matteo PhD; Pelletier, Roxanne PhD; Bos, Elisabeth H. PhD; de Jonge, Peter PhD

doi: 10.1097/PSY.0000000000000174

Objective Using combined individual patient data from prospective studies, we explored sex differences in depression and prognosis post–myocardial infarction (MI) and determined whether disease indices could account for found differences.

Methods Individual patient data analysis of 10,175 MI patients who completed diagnostic interviews or depression questionnaires from 16 prospective studies from the MINDMAPS study was conducted. Multilevel logistic and Cox regression models were used to determine sex differences in prevalence of depression and sex-specific effects of depression on subsequent outcomes.

Results Combined interview and questionnaire data from observational studies showed that 36% (635/1760) of women and 29% (1575/5526) of men reported elevated levels of depression (age-adjusted odds ratio = 0.68, 95% confidence interval [CI] = 0.60–0.77). The risk for all-cause mortality associated with depression was higher in men (hazard ratio = 1.38, 95% CI = 1.30–1.47) than in women (hazard ratio = 1.22, 95% CI = 1.14–1.31; sex by depression interaction: p < .001). Low left ventricular ejection fraction (LVEF) was associated with higher depression scores in men only (sex by LVEF interaction: B = 0.294, 95% CI = 0.090–0.498), which attenuated the sex difference in the association between depression and prognosis.

Conclusions The prevalence of depression post-MI was higher in women than in men, but the association between depression and cardiac prognosis was worse for men. LVEF was associated with depression in men only and accounted for the increased risk of all-cause mortality in depressed men versus women, suggesting that depression in men post-MI may, in part, reflect cardiovascular disease severity.

Supplemental digital content is available in the text.

From the Division of Population Health Sciences (Psychology) (Doyle) and Population Health Sciences (Epidemiology & Public Health Medicine) (Conroy), and Faculty of Medicine & Health Sciences (McGee), Royal College of Surgeons in Ireland, Ireland; Department of Clinical Psychology (Conradi), University of Amsterdam, Amsterdam, the Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation (Meijer, Bos, de Jonge), University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology (Steeds), Queen Elizabeth Hospital, Birmingham, UK; School of Human Welfare Studies (Sato), Kwansei Gakuin University, Nishinomiya, Japan; University Health Network (Stewart), University of Toronto, Toronto, Ontario, Canada; Department of Medicine (Parakh), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Psychiatry (Carney, Freedland), Washington University, St Louis, Missouri; Division of Cardiology (Anselmino), Department of Medical Sciences, University of Turin, Turin, Italy; and McGill University Health Centre (Pelletier), Montréal, Canada.

Supplemental Content

Address correspondence and reprint requests to Frank Doyle, PhD, Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2, Ireland. E-mail:

Received for publication April 8, 2014; revision received January 8, 2015.

Copyright © 2015 by American Psychosomatic Society
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