Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction.
BACKGROUND
Although previous research demonstrated an independent link between depression symptoms and cardiac mortality after myocardial infarction (MI), depression was assessed only once, and a dose-response relationship was not evaluated.


RESULTS
We administered the Beck Depression Inventory to 896 post-MI patients during admission and at 1 year. Five-year survival was ascertained using Medicare data. We observed a significant long-term dose-response relationship between depression symptoms during hospitalization and cardiac mortality. Results remained significant after control for multiple measures of cardiac disease severity. Although 1-year scores were also linked to cardiac mortality, most of that impact was explained by baseline scores. Improvement in depression symptoms was associated with less cardiac mortality only for patients with mild depression. Patients with higher initial scores had worse long-term prognosis regardless of symptom changes.


CONCLUSIONS
The level of depression symptoms during admission for MI is more closely linked to long-term survival than the level at 1 year, particularly in patients with moderate to severe levels of depression, suggesting that the presumed cardiovascular mechanisms linking depression to cardiac mortality may be more or less permanent for them.
Lespérance
François
F
Department of Psychiatry, University of Montreal and McGill University, Canada. francois.lesperance@umontreal.ca
Frasure-Smith
Nancy
N
Talajic
Mario
M
Bourassa
Martial G
MG
D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D011581:Psychological Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate