title: Depressive symptoms in younger women and men with acute myocardial infarction: insights from the VIRGO study.
abstract: BACKGROUND
  Depression was recently recognized as a risk factor for adverse medical outcomes in patients with acute myocardial infarction (AMI). The degree to which depression is present among younger patients with an AMI, the patient profile associated with being a young AMI patient with depressive symptoms, and whether relevant sex differences exist are currently unknown.
  
  
  RESULTS
  The Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study enrolled 3572 patients with AMI (67.1% women; 2:1 ratio for women to men) between 2008 and 2012 (at 103 hospitals in the United States, 24 in Spain, and 3 in Australia). Information about lifetime history of depression and depressive symptoms experienced over the past 2 weeks (Patient Health Questionnaire; a cutoff score ≥10 was used for depression screening) was collected during index AMI admission. Information on demographics, socioeconomic status, cardiovascular risk, AMI severity, perceived stress (14-item Perceived Stress Scale), and health status (Seattle Angina Questionnaire, EuroQoL 5D) was obtained through interviews and chart abstraction. Nearly half (48%) of the women reported a lifetime history of depression versus 1 in 4 in men (24%; P<0.0001). At the time of admission for AMI, more women than men experienced depressive symptoms (39% versus 22%, P<0.0001; adjusted odds ratio 1.64; 95% CI 1.36 to 1.98). Patients with more depressive symptoms had higher levels of stress and worse quality of life (P<0.001). Depressive symptoms were more prevalent among patients with lower socioeconomic profiles (eg, lower education, uninsured) and with more cardiovascular risk factors (eg, diabetes, smoking).
  
  
  CONCLUSIONS
  A high rate of lifetime history of depression and depressive symptoms at the time of an AMI was observed among younger women compared with men. Depressive symptoms affected those with more vulnerable socioeconomic and clinical profiles.
authors.affiliation: University of Missouri Kansas City, Kansas City, MO (K.G.S., J.A.S.) Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S.).
authors.forename: Kim G
authors.initials: KG
authors.lastname: Smolderen
authors.affiliation: Yale School of Public Health, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., S.Z., J.H.L., M.G., H.M.K.).
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Strait
authors.affiliation: Yale School of Public Health, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., S.Z., J.H.L., M.G., H.M.K.).
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Dreyer
authors.affiliation: Department of Emergency Medicine, Yale University, New Haven, CT (G.O., B.S.).
authors.forename: Gail
authors.initials: G
authors.lastname: D'Onofrio
authors.affiliation: Yale School of Public Health, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., S.Z., J.H.L., M.G., H.M.K.).
authors.forename: Shengfan
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Yale School of Public Health, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., S.Z., J.H.L., M.G., H.M.K.).
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.affiliation: Yale School of Public Health, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., S.Z., J.H.L., M.G., H.M.K.).
authors.forename: Mary
authors.initials: M
authors.lastname: Geda
authors.affiliation: Department of Cardiology, Instituto de Investigación Gregorio Marañón and Universidad Complutense de Madrid, Spain (B.).
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: Queen Elizabeth Hospital, University of Adelaide, Australia (J.B.).
authors.forename: John
authors.initials: J
authors.lastname: Beltrame
authors.affiliation: Department of Emergency Medicine, Yale University, New Haven, CT (G.O., B.S.).
authors.forename: Basmah
authors.initials: B
authors.lastname: Safdar
authors.affiliation: Yale School of Public Health, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., S.Z., J.H.L., M.G., H.M.K.) Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, New Haven, CT (H.M.K.).
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: University of Missouri Kansas City, Kansas City, MO (K.G.S., J.A.S.) Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001315:Australia / Q000453:epidemiology; D003863:Depression / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000523:psychology; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: acute myocardial infarction; depression; sex differences
references.citation: Circulation. 2002 Jul 2;106(1):43-9
references.pmid: 12093768
references.citation: JAMA Intern Med. 2013 Jun 10;173(11):997-1004
references.pmid: 23471421
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2003 Jun;38(6):290-6
references.pmid: 12799778
references.citation: JAMA. 2003 Jul 9;290(2):215-21
references.pmid: 12851276
references.citation: Am Heart J. 2003 Dec;146(6):1015-22
references.pmid: 14660993
references.citation: J Health Soc Behav. 1983 Dec;24(4):385-96
references.pmid: 6668417
references.citation: Health Policy. 1990 Dec;16(3):199-208
references.pmid: 10109801
references.citation: Am J Cardiol. 1994 Dec 15;74(12):1240-4
references.pmid: 7977097
references.citation: J Am Coll Cardiol. 1995 Feb;25(2):333-41
references.pmid: 7829785
references.citation: Circulation. 1995 Feb 15;91(4):999-1005
references.pmid: 7531624
references.citation: Health Policy. 1996 Jul;37(1):53-72
references.pmid: 10158943
references.citation: Psychosom Med. 1999 Jan-Feb;61(1):26-37
references.pmid: 10024065
references.citation: N Engl J Med. 1999 Jul 22;341(4):217-25
references.pmid: 10413733
references.citation: Eur J Epidemiol. 2005;20(1):103-11
references.pmid: 15756910
references.citation: J Gen Intern Med. 2006 Jan;21(1):30-8
references.pmid: 16423120
references.citation: Circ Cardiovasc Qual Outcomes. 2009 Jan;2(1):25-32
references.pmid: 20031809
references.citation: Arch Intern Med. 2006 Apr 24;166(8):876-83
references.pmid: 16636213
references.citation: Acta Psychiatr Scand. 2006 May;113(5):372-87
references.pmid: 16603029
references.citation: JAMA. 2009 Nov 18;302(19):2095-103
references.pmid: 19918088
references.citation: Am Heart J. 2009 Feb;157(2):208-18
references.pmid: 19185627
references.citation: JAMA. 2008 Nov 26;300(20):2379-88
references.pmid: 19033588
references.citation: Circulation. 2007 Oct 23;116(17):1925-30
references.pmid: 17923572
references.citation: Circ Cardiovasc Qual Outcomes. 2009 Jan;2(1):33-40
references.pmid: 20031810
references.citation: Circ Cardiovasc Qual Outcomes. 2009 Jul;2(4):344-53
references.pmid: 20031860
references.citation: Crit Pathw Cardiol. 2010 Jun;9(2):82-7
references.pmid: 20520215
references.citation: Circ Cardiovasc Qual Outcomes. 2010 Nov;3(6):684-93
references.pmid: 21081748
references.citation: Am Heart J. 2012 May;163(5):790-6
references.pmid: 22607856
references.citation: J Am Coll Cardiol. 2012 Oct 30;60(18):1756-63
references.pmid: 23040574
references.citation: Ann Intern Med. 2001 Feb 6;134(3):173-81
references.pmid: 11177329
references.citation: JAMA. 1999 Nov 10;282(18):1737-44
references.pmid: 10568646
references.citation: Eur Heart J. 2014 Jun 1;35(21):1365-72
references.pmid: 24282187
references.citation: Circulation. 2014 Mar 25;129(12):1350-69
references.pmid: 24566200
references.citation: J Affect Disord. 2003 Mar;74(1):5-13
references.pmid: 12646294