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Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis

Published online by Cambridge University Press:  20 August 2009

E. J. Martens ,
P. W. Hoen ,
M. Mittelhaeuser ,
P. de Jonge  and
J. Denollet
E. J. Martens*
Affiliation:
CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, The Netherlands Department of Education and Research, Catharina Hospital Eindhoven, The Netherlands
P. W. Hoen
Affiliation:
Department of Psychiatry, University of Groningen, The Netherlands
M. Mittelhaeuser
Affiliation:
CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, The Netherlands
P. de Jonge
Affiliation:
CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, The Netherlands Department of Psychiatry, University of Groningen, The Netherlands
J. Denollet
Affiliation:
CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, The Netherlands
*
*Address for correspondence: E. J. Martens, Ph.D., CoRPS, Department of Medical Psychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands. (Email: [email protected])
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Abstract

Background

Individual symptoms of post-myocardial infarction (MI) depression may be differentially associated with cardiac prognosis, in which somatic/affective symptoms appear to be associated with a worse cardiovascular prognosis than cognitive/affective symptoms. These findings hold important implications for treatment but need to be replicated before conclusions regarding treatment can be drawn. We therefore examined the relationship between depressive symptom dimensions following MI and both disease severity and prospective cardiac prognosis.

Method

Patients (n=473) were assessed on demographic and clinical variables and completed the Beck Depression Inventory (BDI) within the first week of hospital admission for acute MI. Depressive symptom dimensions were associated with baseline left ventricular ejection fraction (LVEF) and prospective cardiac death and/or recurrent MI. The average follow-up period was 2.8 years.

Results

Factor analysis revealed two symptom dimensions – somatic/affective and cognitive/affective – in the underlying structure of the BDI, identical to previous results. There were 49 events attributable to cardiac death (n=23) or recurrent MI (n=26). Somatic/affective (p=0.010) but not cognitive/affective (p=0.153) symptoms were associated with LVEF and cardiac death/recurrent MI. When controlling for the effects of previous MI and LVEF, somatic/affective symptoms remained significantly predictive of cardiac death/recurrent MI (hazard ratio 1.31, 95% confidence interval 1.02–1.69, p=0.038). Previous MI was also an independent predictor of cardiac death/recurrent MI.

Conclusions

We confirmed that somatic/affective, rather than cognitive/affective, symptoms of depression are associated with MI severity and cardiovascular prognosis. Interventions to improve cardiovascular prognosis by treating depression should be targeted at somatic aspects of depression.

Keywords

Depressionmyocardial infarctionprognosis
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 5 , May 2010 , pp. 807 - 814
Copyright
Copyright © Cambridge University Press 2009

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References

Barbour, KA, Edenfield, TM, Blumenthal, JA (2007). Exercise as a treatment for depression and other psychiatric disorders: a review. Journal of Cardiopulmonary Rehabilitation and Prevention 27, 359–367.CrossRefGoogle ScholarPubMed
Barth, J, Schumacher, M, Herrmann-Lingen, C (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine 66, 802–813.CrossRefGoogle ScholarPubMed
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Berkman, LF, Blumenthal, J, Burg, M, Carney, RM, Catellier, D, Cowan, MJ, Czajkowski, SM, DeBusk, R, Hosking, J, Jaffe, A, Kaufmann, PG, Mitchell, P, Norman, J, Powell, LH, Raczynski, JM, Schneiderman, N (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. Journal of the American Medical Association 289, 3106–3116.Google ScholarPubMed
Carney, RM, Blumenthal, JA, Catellier, D, Freedland, KE, Berkman, LF, Watkins, LL, Czajkowski, SM, Hayano, J, Jaffe, AS (2003). Depression as a risk factor for mortality after acute myocardial infarction. American Journal of Cardiology 392, 1277–1281.CrossRefGoogle Scholar
Carney, RM, Freedland, KE, Jaffe, AS, Frasure-Smith, N, Lesperance, F, Sheps, DS, Glassman, AH, O'Connor, CM, Blumenthal, JA, Kaufmann, PG, Czajkowski, SM (2004). Depression as a risk factor for post-MI mortality. Journal of the American College of Cardiology 44, 472–474.CrossRefGoogle ScholarPubMed
Davidson, KW, Kupfer, DJ, Bigger, JT, Califf, RM, Carney, RM, Coyne, JC, Czajkowski, SM, Frank, E, Frasure-Smith, N, Freedland, KE, Froelicher, ES, Glassman, AH, Katon, WJ, Kaufmann, PG, Kessler, RC, Kraemer, HC, Krishnan, KR, Lesperance, F, Rieckmann, N, Sheps, DS, Suls, JM (2006). Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report. Psychosomatic Medicine 68, 645–650.CrossRefGoogle ScholarPubMed
De Jonge, P, Denollet, J, van Melle, JP, Kuyper, A, Honig, A, Schene, AH, Ormel, J (2007 a). Associations of type D personality and depression with somatic health in myocardial infarction patients. Journal of Psychosomatic Research 63, 477–482.CrossRefGoogle ScholarPubMed
De Jonge, P, Mangano, D, Whooley, MA (2007 b). Differential association of cognitive and somatic depressive symptoms with heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. Psychosomatic Medicine 69, 735–739.CrossRefGoogle ScholarPubMed
De Jonge, P, Ormel, J, van den Brink, RH, van Melle, JP, Spijkerman, TA, Kuijper, A, van Veldhuisen, DJ, van den Berg, MP, Honig, A, Crijns, HJ, Schene, AH (2006). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry 163, 138–144.CrossRefGoogle ScholarPubMed
Frasure-Smith, N, Lesperance, F, Talajic, M (1995). Depression and 18-month prognosis after myocardial infarction. Circulation 91, 999–1005.CrossRefGoogle ScholarPubMed
Glassman, AH, O'Connor, CM, Califf, RM, Swedberg, K, Schwartz, P, Bigger, JT Jr., Krishnan, KR, van Zyl, LT, Swenson, JR, Finkel, MS, Landau, C, Shapiro, PA, Pepine, CJ, Mardekian, J, Harrison, WM, Barton, D, Mclvor, M (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. Journal of the American Medical Association 288, 701–709.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Lane, D, Carroll, D, Lip, GY (2003). Anxiety, depression, and prognosis after myocardial infarction: is there a causal association? Journal of the American College of Cardiology 42, 1808–1810.CrossRefGoogle ScholarPubMed
Lane, D, Carroll, D, Ring, C, Beevers, DG, Lip, GY (2001). Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety. Psychosomatic Medicine 63, 221–230.CrossRefGoogle ScholarPubMed
Lespérance, F, Frasure-Smith, N, Koszycki, D, Laliberte, MA, van Zyl, LT, Baker, B, Swenson, JR, Ghatavi, K, Abramson, BL, Dorian, P, Guertin, MC (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. Journal of the American Medical Association 297, 367–379.CrossRefGoogle ScholarPubMed
Lespérance, F, Frasure-Smith, N, Talajic, M, Bourassa, MG (2002). Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation 105, 1049–1053.CrossRefGoogle ScholarPubMed
Lett, H, Ali, S, Whooley, M (2008). Depression and cardiac function in patients with stable coronary heart disease: findings from the Heart and Soul Study. Psychosomatic Medicine 70, 444–449.CrossRefGoogle ScholarPubMed
Nicholson, A, Kuper, H, Hemingway, H (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal 27, 2763–2774.CrossRefGoogle Scholar
Schiffer, AA, Pelle, AJ, Smith, OR, Widdershoven, JW, Hendriks, EH, Pedersen, SS (in press). Somatic versus cognitive symptoms of depression as predictors of mortality and health status in chronic heart failure. Journal of Clinical Psychiatry.Google Scholar
Smolderen, KG, Spertus, JA, Reid, KJ, Buchanan, DM, Krumholz, HM, Denollet, J, Vaccarino, V, Chan, PS (2009). The association of cognitive and somatic depressive symptoms with depression recognition and outcomes after myocardial infarction. Circulation: Cardiovascular Quality and Outcomes 2, 328–337.Google ScholarPubMed
Sørensen, C, Friis-Hasché, E, Haghfelt, T, Bech, P (2005). Postmyocardial infarction mortality in relation to depression: a systematic critical review. Psychotherapy and Psychosomatics 74, 69–80.CrossRefGoogle Scholar
Thombs, BD, Grace, SL, Ziegelstein, RC (2006). Do symptom dimensions of depression following myocardial infarction relate differently to physical health indicators and cardiac prognosis? American Journal of Psychiatry 163, 1295–1296.CrossRefGoogle ScholarPubMed
Van Melle, JP, de Jonge, P, Honig, A, Schene, AH, Kuyper, AM, Crijns, HJ, Schins, A, Tulner, D, van den Berg, MP, Ormel, J (2007). Effects of antidepressant treatment following myocardial infarction. British Journal of Psychiatry 190, 460–466.CrossRefGoogle ScholarPubMed
Van Melle, JP, de Jonge, P, Ormel, J, Crijns, HJ, van Veldhuisen, DJ, Honig, A, Schene, AH, van den Berg, MP (2005). Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND-IT. European Heart Journal 26, 2650–2656.CrossRefGoogle ScholarPubMed
Van Melle, JP, de Jonge, P, Spijkerman, TA, Tijssen, JG, Ormel, J, van Veldhuisen, DJ, van den Brink, RH, van den Berg, MP (2004). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosomatic Medicine 66, 814–822.CrossRefGoogle ScholarPubMed
Watkins, LL, Schneiderman, N, Blumenthal, JA, Sheps, DS, Catellier, D, Taylor, CB, Freedland, KE (2003). Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction. American Heart Journal 146, 48–54.CrossRefGoogle ScholarPubMed