Predictors of depressive disorder following acute coronary syndrome: Results from K-DEPACS and EsDEPACS.
BACKGROUND
Depression is common and associated with poor prognosis in acute coronary syndrome (ACS). There are few reports on the predictors of incident and persistent post-discharge depressive disorders in ACS. This study aimed to investigate the incidence and persistence of depressive disorder over a one year follow-up, and predictors of these outcomes.


METHODS
1152 patients with recently developed ACS were recruited at baseline, and 828 were followed one year thereafter. Depressive disorder (major and minor) was diagnosed according to DSM-IV criteria, and analyzed according to baseline prevalence, and follow up incidence and persistence. Of 446 baseline participants with depressive disorders, 300 were randomized to a 24-week double blind trial of escitalopram or placebo, while the remaining 146 received medical treatment as usual. Associations of baseline socio-demographic and clinical characteristics with depressive disorder were investigated using logistic regression models.


RESULTS
Two-week prevalence, and one-year incidence and persistence of depressive disorder were 38.7%, 13.1%, and 46.3%, respectively. Baseline depressive disorder was independently associated with female, lower educational level, previous ACS and higher heart rate. Incident depressive disorder was independently predicted by current unemployment, family history of depression, higher baseline Hamilton Depression Rating Scale(HAMD) score and lower left ventricular ejection fraction, and persistent depressive disorder by higher baseline HAMD score and the placebo or medical treatment as usual group in the 24-week trial.


CONCLUSIONS
The generalizability should be considered since this study conducted in a single center.


CONCLUSIONS
Depressive disorder in ACS patients is common and often persistent, and is associated with baseline characteristics and insufficient treatment. Appropriate detection and treatment of depressive disorder are clearly important in ACS patients.
Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
Hee-Ju
HJ
Kang
King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Robert
R
Stewart
Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
Kyung-Yeol
KY
Bae
Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
Sung-Wan
SW
Kim
Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
Il-Seon
IS
Shin
Departments of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea.
Young Joon
YJ
Hong
Departments of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea.
Youngkeun
Y
Ahn
Departments of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea.
Myung Ho
MH
Jeong
Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
Jin-Sang
JS
Yoon
Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea. Electronic address: jmkim@chonnam.ac.kr.
Jae-Min
JM
Kim
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015283:Citalopram / Q000627:therapeutic use*; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
D015283:Citalopram
Acute coronary syndrome; Depressive disorder; Depressive symptoms; Escitalopram; Predictor