Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events.
OBJECTIVE
The purpose of this research was to study whether incident and non-incident depression after myocardial infarction (MI) are differentially associated with prospective fatal and non-fatal cardiovascular events.


BACKGROUND
Post-MI depression is defined as the presence of depression after MI. However, only about one-half of post-MI depressions represent an incident episode, whereas the other half are ongoing or recurrent depressions. We investigated whether these subtypes differ in cardiovascular prognosis.


METHODS
A total of 468 MI patients were assessed for the presence of an International Classification of Diseases-10 depressive disorder during the year after index MI. A comparison was made on new cardiovascular events (mean follow up: 2.5 years) between patients with no, incident, and non-incident post-MI depression by survival analysis.


RESULTS
Compared with non-depressed patients, those with an incident depression had an increased risk of cardiovascular events (hazard ratio [HR] 1.65; 95% confidence interval [CI] 1.02 to 2.65), but not those with a non-incident depression (HR 1.12; 95% CI 0.61 to 2.06), which remained after controlling for confounders (HR 1.76; 95% CI 1.06 to 2.93 and HR 1.39; 95% CI 0.74 to 2.61, respectively).


CONCLUSIONS
Only patients with incident post-MI depression have an impaired cardiovascular prognosis. A more detailed subtyping of post-MI depression is needed, based on an integration of recent findings on the differential impact of depression symptom profiles and personality on cardiac outcomes.
de Jonge
Peter
P
Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. p.de.jonge@med.umcg.nl
van den Brink
Rob H S
RH
Spijkerman
Titia A
TA
Ormel
Johan
J
D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D003866:Depressive Disorder / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D006233:Persons with Disabilities; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D009204:Myocardial Revascularization; D009497:Neurotic Disorders / Q000150:complications; D010551:Personality; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology