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The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up

Bürker, Britta S. MD; Gullestad, Lars MD, PhD; Gude, Einar MD, PhD; Havik, Odd E. PhD; Relbo Authen, Anne RN; Grov, Ingelin RN; Andreassen, Arne K. MD, PhD; Fiane, Arnt E. MD, PhD; Haraldsen, Ira R. MD, PhD; Dew, Mary Amanda PhD; Andersson, Stein PhD; Malt, Ulrik F. MD, PhD

doi: 10.1097/PSY.0000000000000702

Objective Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified and whether they were differentially associated with mortality.

Methods Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventory – version 1A [BDI-1A]), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni- and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables.

Results Clinically significant depression was a significant predictor of mortality (hazard ratio = 2.088; 95% confidence interval = 1.366–3.192; p = .001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (hazard ratio = 1.982; 95% confidence interval = 1.220–3.217; p = .006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, whereas neither of the two subscales was an independent predictor of mortality in the multivariate analysis.

Conclusions Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.

From the Institute of Clinical Medicine (Bürker, Gullestad, Fiane, Malt), University of Oslo; Department of Psychiatry of Old Age (Bürker), Oslo University Hospital – Ullevål; Departments of Psychosomatic Medicine (Bürker, Haraldsen), Cardiology (Gullestad, Gude, Relbo Authen, Grov, Andreassen), and Cardiothoracic Surgery (Fiane), Oslo University Hospital – Rikshospitalet; K.G. Jebsen Centre for Cardiac Research (Gullestad), University of Oslo; Centre for Heart Failure Research (Gullestad), Oslo University Hospital, Oslo, Norway; Department of Clinical Psychology (Havik), University of Bergen, Bergen, Norway; Department of Psychiatry (Dew), University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Psychology (Andersson), University of Oslo, Oslo, Norway; and Department of Research and Education (Malt), Oslo University Hospital – Rikshospitalet, Norway.

Address correspondence to Britta S. Bürker, MD, c/o S. Andersson, Department of Psychology, University of Oslo, Pb. 1094 Blindern, 0317 Oslo, Norway. E-mail:

Supplemental Content

All authors contributed to the interpretation of data and revised the article critically. All authors approved the final and submitted version. The specific author contributions were as follows: B.S.B. updated the database, analyzed the data, and drafted the article. L.G. participated in designing the main study and supported the update of the database. O.E.H. participated in designing the main study. A.R.A. and I.G. participated in collecting data for the main study and supported the update of the database.

Received for publication June 4, 2018; revision received January 24, 2019.

Online date: April 25, 2019

Copyright © 2019 by American Psychosomatic Society
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