title: Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis.
abstract: OBJECTIVE
  To assess the association of depression following myocardial infarction (MI) and cardiovascular prognosis.
  
  
  METHODS
  The authors performed a meta-analysis of references derived from MEDLINE, EMBASE, and PSYCINFO (1975-2003) combined with crossreferencing without language restrictions. The authors selected prospective studies that determined the association of depression with the cardiovascular outcome of MI patients, defined as mortality and cardiovascular events within 2 years from index MI. Depression had to be assessed within 3 months after MI using established psychiatric instruments. A quality assessment was performed.
  
  
  RESULTS
  Twenty-two papers met the selection criteria. These studies described follow up (on average, 13.7 months) of 6367 MI patients (16 cohorts). Post-MI depression was significantly associated with all-cause mortality (odds ratio [OR], fixed 2.38; 95% confidence interval [CI], 1.76-3.22; p <.00001) and cardiac mortality (OR fixed, 2.59; 95% CI, 1.77-3.77; p <.00001). Depressive MI patients were also at risk for new cardiovascular events (OR random, 1.95; 95% CI, 1.33-2.85; p = .0006). Secondary analyses showed no significant effects of follow-up duration (0-6 months or longer) or assessment of depression (self-report questionnaire vs. interview). However, the year of data collection (before or after 1992) tended to influence the effect of depression on mortality (p = .08), with stronger associations found in the earlier studies (OR, 3.22; 95% CI, 2.14-4.86) compared with the later studies (OR, 2.01; 95% CI, 1.45-2.78).
  
  
  CONCLUSIONS
  Post-MI depression is associated with a 2- to 2.5-fold increased risk of impaired cardiovascular outcome. The association of depression with cardiac mortality or all-cause mortality was more pronounced in the older studies (OR, 3.22 before 1992) than in the more recent studies (OR, 2.01 after 1992).
authors.affiliation: Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB, The Netherlands. j.p.van.melle@thorax.azg.nl
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.forename: Titia A
authors.initials: TA
authors.lastname: Spijkerman
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Johan
authors.initials: J
authors.lastname: Ormel
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Rob H S
authors.initials: RH
authors.lastname: van den Brink
authors.forename: Maarten P
authors.initials: MP
authors.lastname: van den Berg
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D010555:Personality Inventory; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales