title: Depression and long-term mortality risk in patients with coronary artery disease.
abstract: Previous research has established that patients with coronary artery disease (CAD) have an increased risk of death if they are depressed at the time of hospitalization. Follow-up periods have been short in these studies; therefore, the present investigation examined this phenomenon over an extended period of time. Patients with established CAD (n = 1,250) were assessed for depression with the Zung Self-Rating Depression Scale (SDS) and followed for subsequent mortality. Follow-up ranged up to 19.4 years. SDS scores were associated with increased risk of subsequent cardiac death (p = 0.002) and total mortality (p < 0.001) after controlling for initial disease severity and treatment. Patients with moderate to severe depression had a 69% greater odds of cardiac death and a 78% greater odds of mortality from all causes than nondepressed patients. Increased risk was not confined to the initial months after hospitalization. Patients with high SDS scores at baseline still had a higher risk of cardiac death > 5 years later (p < 0.005). Compared with the nondepressed, patients with moderate to severe depression had an 84% greater risk 5 to 10 years later and a 72% greater risk after > 10 years. Patients with mild depression had intermediate levels of risk in all models. The heightened long-term risk of depressed patients suggests that depression may be persistent or frequently recurrent in CAD patients and is associated with CAD progression, triggering of acute events, or both.
authors.affiliation: Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Barefoot
authors.forename: M J
authors.initials: MJ
authors.lastname: Helms
authors.forename: D B
authors.initials: DB
authors.lastname: Mark
authors.forename: J A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: T L
authors.initials: TL
authors.lastname: Haney
authors.forename: C M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: I C
authors.initials: IC
authors.lastname: Siegler
authors.forename: R B
authors.initials: RB
authors.lastname: Williams
mesh_terms: D003327:Coronary Disease / Q000150:complications* / Q000401:mortality*; D003863:Depression / Q000150:complications*; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis