title: Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis.
abstract: BACKGROUND
  The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity.
  
  
  OBJECTIVE
  To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity.
  
  
  METHODS
  An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses.
  
  
  RESULTS
  Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26-1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14-1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively.
  
  
  CONCLUSIONS
  The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.
authors.affiliation: Interdisciplinary Centre for Psychiatric Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Meijer
authors.forename: H J
authors.initials: HJ
authors.lastname: Conradi
authors.forename: E H
authors.initials: EH
authors.lastname: Bos
authors.forename: M
authors.initials: M
authors.lastname: Anselmino
authors.forename: R M
authors.initials: RM
authors.lastname: Carney
authors.forename: J
authors.initials: J
authors.lastname: Denollet
authors.forename: F
authors.initials: F
authors.lastname: Doyle
authors.forename: K E
authors.initials: KE
authors.lastname: Freedland
authors.forename: S L
authors.initials: SL
authors.lastname: Grace
authors.forename: S H
authors.initials: SH
authors.lastname: Hosseini
authors.forename: D A
authors.initials: DA
authors.lastname: Lane
authors.forename: L
authors.initials: L
authors.lastname: Pilote
authors.forename: K
authors.initials: K
authors.lastname: Parakh
authors.forename: C
authors.initials: C
authors.lastname: Rafanelli
authors.forename: H
authors.initials: H
authors.lastname: Sato
authors.forename: R P
authors.initials: RP
authors.lastname: Steeds
authors.forename: C
authors.initials: C
authors.lastname: Welin
authors.forename: P
authors.initials: P
authors.lastname: de Jonge
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D003866:Depressive Disorder / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D012306:Risk; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires