title: Changing depressive symptoms following percutaneous coronary intervention, clustering and effect on adherence - The THORESCI study.
abstract: Depressive symptom dimensions may have a differential effect on cardiac prognosis. It is yet unknown whether and how depressive symptoms change together over time and how this may affect disease progression. We examined the clustering of changing depressive symptoms over the first 6 months after percutaneous coronary intervention (PCI), and examined the influence of the change profile on the predictive value of depression for treatment adherence at 6 months post-PCI.
  
  
  
  PCI patients (N=219, age: 62±15, 20% women) reported on depressive symptoms (PHQ-9, BDI; 30 symptoms) and adherence (MOS-GAS) at 1 and 6 months post-PCI. Principal component analysis (PCA) was performed on the individual symptom change scores. Multivariable linear regression examined the role of change profiles in predicting general treatment adherence, while adjusting for demographic and clinical characteristics.
  
  
  
  Four change-factors emerged from PCA. One somatic-affective change-factor (10 symptoms), two cognitive-affective change-factors (6 general cognitive-affective and 7 severe cognitive symptoms) and one mixed factor were identified. We extracted 5 symptom change profiles. Linear regression showed the moderating role of the change profiles. In patients reporting a net increase in depressive symptoms, higher cognitive affective symptoms (β=-.46, p=.001) and higher somatic-affective symptoms (β=-.29; p=.044) were associated with worse general adherence.
  
  
  
  Four distinct depressive symptom change-factors were identified that moderated the association of somatic-affective and cognitive-affective depressive symptom levels with general treatment adherence. This is of clinical importance as not only current symptoms, but also symptom change over the preceding months may be important to consider in screening and risk prediction.
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical & Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: Versteeg
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical & Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Eveline
authors.initials: E
authors.lastname: van Montfort
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical & Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical & Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Nina
authors.initials: N
authors.lastname: Kupper
mesh_terms: D000342:Affective Symptoms / Q000188:drug therapy / Q000523:psychology*; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy / Q000209:etiology / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000523:psychology*; D011183:Postoperative Complications; D011184:Postoperative Period; D025341:Principal Component Analysis; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents
keywords: Change; Depression dimensions; Depressive symptoms; Percutaneous coronary intervention; Treatment adherence