Timing is everything: the onset of depression and acute coronary syndrome outcome.
BACKGROUND
Conflicting findings have emerged from studies examining the impact of depression on death and readmission following a coronary event, possibly reflecting differences in the measurement of "depression" and the onset of depression in relation to the coronary event. The aim of this study was to examine the relationship between the timing of the depressive episode and 1-year cardiovascular outcome in recruited patients with acute coronary syndrome (ACS).


METHODS
Patients hospitalized with ACS (N = 489) were recruited and assessed for lifetime and current depression by the Composite International Diagnostic Interview (CIDI) depression schedule. Patients were reinterviewed at 1 and 12 months by telephone to assess depression status and cardiovascular outcomes (ACS readmission and cardiac mortality). Mortality registers were also checked.


RESULTS
Cardiovascular outcome was not associated with the presence of lifetime depression before the ACS admission or with existing depression at the time of the ACS admission. In contrast, depression that developed in the month after the ACS event showed a strong relationship with subsequent cardiovascular outcome, even after controlling for traditional cardiac risk factors. Outcome over the 12 months was more strongly predicted by the timing of depression onset than whether the depression was a first-ever (incident) or recurrent episode.


CONCLUSIONS
Only a depressive episode that commenced following an ACS admission was associated with a poorer cardiovascular outcome. If confirmed, this finding would narrow the list of causal mechanisms previously proposed to account for the relationship between depression and coronary events.
Parker
Gordon B
GB
Black Dog Institute, Prince of Wales Hospital, Randwick, Australia; School of Psychiatry, University of New South Wales, Randwick, Australia. Electronic address: g.parker@unsw.edu.au.
Hilton
Therese M
TM
Black Dog Institute, Prince of Wales Hospital, Randwick, Australia; School of Psychiatry, University of New South Wales, Randwick, Australia.
Walsh
Warren F
WF
Department of Cardiac Services, Prince of Wales Hospital, Randwick, Australia.
Owen
Catherine A
CA
Black Dog Institute, Prince of Wales Hospital, Randwick, Australia; School of Psychiatry, University of New South Wales, Randwick, Australia.
Heruc
Gabriella A
GA
Black Dog Institute, Prince of Wales Hospital, Randwick, Australia; School of Psychiatry, University of New South Wales, Randwick, Australia.
Olley
Amanda
A
Black Dog Institute, Prince of Wales Hospital, Randwick, Australia; School of Psychiatry, University of New South Wales, Randwick, Australia.
Brotchie
Heather
H
Black Dog Institute, Prince of Wales Hospital, Randwick, Australia; School of Psychiatry, University of New South Wales, Randwick, Australia.
Hadzi-Pavlovic
Dusan
D
Black Dog Institute, Prince of Wales Hospital, Randwick, Australia; School of Psychiatry, University of New South Wales, Randwick, Australia.
D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000523:psychology*; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors