Longitudinal course of depressive symptomatology after a cardiac event: effects of gender and cardiac rehabilitation.
OBJECTIVE
Recent research has linked depression to cardiac mortality, and shown a high burden of persistent depressive symptomatology among cardiac patients. The objective of this study was to longitudinally examine the prevalence and course of depressive symptomatology among women and men for 1 year after a cardiac event, and the effect of cardiac rehabilitation (CR) on this trajectory.


METHODS
Nine hundred thirteen unstable angina (UA) and myocardial infarction patients from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months. Measures included CR participation, medication usage, and the Beck Depression Inventory (BDI). The longitudinal analysis was conducted using SAS PROC MIXED.


RESULTS
At baseline there were 277 (31.3%) participants with elevated depressive symptomatology (BDI > or = 10), 131 (25.2%) at 6 months, and 107 (21.7%) at 1 year. Overall, approximately 5% were taking an antidepressant medication, and 20% attended CR over their year of recovery. Participants with greater depressive symptomatology participated in significantly fewer CR exercise sessions (r = -0.19, p = .02), and minimal psychosocial interventions were offered. The longitudinal analysis revealed that all participants experienced reduced depressive symptomatology over their year of recovery (p = .04), and younger, UA participants with lower family income fared worst (ps < 0.001). CR did not have an effect on depressive symptomatology over time, but women who attended CR were significantly more depressed than men (p = .01).


CONCLUSIONS
Depressed cardiac patients are undertreated and their symptomatology persists for up to 6 months. CR programs require greater resources to ensure that depressed participants adhere to exercise regimens, and are screened and treated for their elevated symptomatology.
Grace
Sherry L
SL
Women's Health Program, Toronto General Research Institute, Behavioural Sciences and Health Division, and Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada. sgrace@yorku.ca
Abbey
Susan E
SE
Pinto
Ruxandra
R
Shnek
Zachary M
ZM
Irvine
Jane
J
Stewart
Donna E
DE
D000367:Age Factors; D000789:Angina, Unstable / Q000453:epidemiology* / Q000534:rehabilitation*; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003325:Coronary Care Units; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000534:rehabilitation*; D010555:Personality Inventory; D011203:Poverty; D015995:Prevalence; D012737:Sex Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents