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CLINICAL RESEARCH: MYOCARDIAL INFARCTION AND DEPRESSION

Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events

Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands

Manuscript received February 17, 2006; revised manuscript received June 5, 2006, accepted June 6, 2006.

^_* Reprint requests and correspondence: Dr. Peter de Jonge, Departments of Internal Medicine and Psychiatry, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands. (Email: p.de.jonge{at}med.umcg.nl).

OBJECTIVES: The purpose of this research was to study whether incident and non-incident depression after myocardial infarction (MI) are differentially associated with prospective fatal and non-fatal cardiovascular events.

BACKGROUND: Post-MI depression is defined as the presence of depression after MI. However, only about one-half of post-MI depressions represent an incident episode, whereas the other half are ongoing or recurrent depressions. We investigated whether these subtypes differ in cardiovascular prognosis.

METHODS: A total of 468 MI patients were assessed for the presence of an International Classification of Diseases-10 depressive disorder during the year after index MI. A comparison was made on new cardiovascular events (mean follow up: 2.5 years) between patients with no, incident, and non-incident post-MI depression by survival analysis.

RESULTS: Compared with non-depressed patients, those with an incident depression had an increased risk of cardiovascular events (hazard ratio [HR] 1.65; 95% confidence interval [CI] 1.02 to 2.65), but not those with a non-incident depression (HR 1.12; 95% CI 0.61 to 2.06), which remained after controlling for confounders (HR 1.76; 95% CI 1.06 to 2.93 and HR 1.39; 95% CI 0.74 to 2.61, respectively).

CONCLUSIONS: Only patients with incident post-MI depression have an impaired cardiovascular prognosis. A more detailed subtyping of post-MI depression is needed, based on an integration of recent findings on the differential impact of depression symptom profiles and personality on cardiac outcomes.

Abbreviations and Acronyms   ACS = acute coronary syndromes   CBT = cognitive behavioral therapy   CI = confidence interval   CIDI = Composite International Diagnostic Interview   ENRICHD = Enhancing Recovery in Coronary Heart Disease trial   HR = hazard ratio   MI = myocardial infarction

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