Depression as a Risk Factor for Mortality in Patients With Coronary Heart Disease: A Meta-analysis

Department of Rehabilitation Psychology, Institute of Psychology, University of Freiburg, Germany.
Psychosomatic Medicine (Impact Factor: 3.47). 11/2004; 66(6):802-13. DOI: 10.1097/01.psy.0000146332.53619.b2
Source: PubMed


Prospective studies on physically healthy subjects have shown an association between depression and the subsequent development of coronary heart disease (CHD). The relative risk in meta-analytic aggregation is 1.64 (confidence interval [CI], 1.29-2.08) for any CHD event. However, the adverse impact of depression on CHD patients has not yet been the subject of a meta-analysis.
To quantify the impact of depressive symptoms (eg, BDI, HADS) or depressive disorders (major depression) on cardiac or all-cause mortality. We analyzed the strength of the relationship, the time dependency, and the differences in studies using depressive symptoms or a clinical diagnosis as predictors of mortality.
English and German language databases (Medline, PsycInfo, PSYNDEX) from 1980 to 2003 were searched for prospective cohort studies. Sixty-two publications were identified. The inclusion criteria were met by 29 publications reporting on 20 studies. A random model was used to estimate the combined overall effect as crude odds ratios (OR) or adjusted hazard ratios (HR [adj]).
Depressive symptoms increase the risk of mortality in CHD patients. The risk of depressed patients dying in the 2 years after the initial assessment is two times higher than that of nondepressed patients (OR, 2.24; 1.37-3.60). This negative prognostic effect also remains in the long-term (OR, 1.78; 1.12-2.83) and after adjustment for other risk factors (HR [adj], 1.76; 1.27-2.43). The unfavorable impact of depressive disorders was reported for the most part in the form of crude odds ratios. Within the first 6 months, depressive disorders were found to have no significant effect on mortality (OR, 2.07; CI, 0.82-5.26). However, after 2 years, the risk is more than two times higher for CHD patients with clinical depression (OR, 2.61; 1.53-4.47). Only three studies reported adjusted hazard ratios for clinical depression and supported the results of the bivariate models.
Depressive symptoms and clinical depression have an unfavorable impact on mortality in CHD patients. The results are limited by heterogeneity of the results in the primary studies. There is no clear evidence whether self-report or clinical interview is the more precise predictor. Nevertheless, depression has to be considered a relevant risk factor in patients with CHD.

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    • "Major depressive disorder (MDD) increases the risk for cardiovascular morbidity and mortality (Barth et al., 2004; Nicholson et al., 2006). While the precise mechanisms for this cardiac vulnerability are unknown, a reduction of heart rate variability (HRV) is thought to be one of the important pathophysiological factors (Agelink et al., 2001; Thayer and Lane, 2007). "
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    ABSTRACT: Evidence from previous studies suggests that heart rate variability (HRV) is reduced in major depressive disorder (MDD). However, whether this reduction is attributable to the disorder per se or to medication, since antidepressants may also affect HRV, is still debated. There is a dearth of information regarding the effects of agomelatine, a novel antidepressant, on HRV. Here, we investigated whether HRV is reduced in MDD and compared the effects of agomelatine and paroxetine on HRV. We recruited 618 physically healthy unmedicated patients with MDD and 506 healthy volunteers aged 20-65 years. Frequency-domain measures of resting HRV were obtained at the time of enrollment for all participants. For patients with MDD, these measures were obtained again after 6weeks of either agomelatine or paroxetine monotherapy. Compared with healthy subjects, unmedicated patients with MDD exhibited significantly lower variance (total HRV), low frequency (LF), and high frequency (HF) HRV, and a higher LF/HF ratio. Depression severity independently contributed to decreased HRV and vagal tone. Fifty-six patients completed the open-label trial (n=29 for agomelatine, n=27 for paroxetine). Between-group analyses showed a significant group-by-time interaction for LF-HRV and HF-HRV, driven by increases in LF-HRV and HF-HRV only after agomelatine treatment. Within the paroxetine-treated group, there were no significant changes in mean R-R intervals or any HRV indices. We therefore concluded that MDD is associated with reduced HRV, which is inversely related to depression severity. Compared with paroxetine, agomelatine has a more vagotonic effect, suggesting greater cardiovascular safety. Clinicians should consider HRV effects while selecting antidepressants especially for depressed patients who already have decreased cardiac vagal tone. Copyright © 2015. Published by Elsevier Inc.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 07/2015; 64. DOI:10.1016/j.pnpbp.2015.07.007 · 3.69 Impact Factor
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    • "Please cite this article as: Dulfer K, et al, Prognostic value of type D personality for 10-year mortality and subjective health status in patients treated with percutaneous coronary intervention, J Psychosom Res (2015), In addition, several studies reported on the prognostic value of depressive symptoms on mortality in HF patients [14] [15]. Coyne and de Voogd [11] questioned whether type D personality is sufficiently distinct from other negative affect variables, especially since depressive symptoms highly correlate with the NA component of type D personality . "
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    ABSTRACT: Given the debate around limitations and controversies in type D personality studies, we aimed to evaluate the prognostic value of 'synergistically' analyzed type D personality (interaction z-scores negative affectivity NA, and social inhibition SI) on 10-year mortality and on 10-year subjective health status in percutaneous coronary intervention (PCI) patients. This prospective study comprised a cohort of 1190 consecutive patients who underwent PCI between October 2001 and September 2002 (73% male, mean age: 62years, range [27-90]years). At baseline, type D personality (DS14), and depression/anxiety (HADS) were assessed. Primary endpoint was 10year all-cause mortality; secondary endpoint was 10-year subjective health status (SF-36). After a median follow-up of 10.3years (IQR 9.8-10.8), 293 deaths of any cause (24.6%) were recorded. After adjustment for significant baseline characteristics, personality categories approached and dichotomously approached type D personality were associated with 10-year mortality, p<.05. Synergistically approached type D personality was not associated with all-cause mortality or subjective health status at 10years. In survivors, higher NA was associated with lower subjective health status. Type D was not associated with mortality after adjusting for continuous depression and anxiety in all approaches. Synergistically analyzed type D was not associated with 10-year all-cause mortality in PCI patients whereas dichotomous type D was. However, after adjustment for depression most of the findings had disappeared. Depression played an important role in this. Type D was not associated with 10-year subjective health status. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of psychosomatic research 06/2015; 79(3). DOI:10.1016/j.jpsychores.2015.05.014 · 2.74 Impact Factor
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    • "On the other hand, depression has been found to be associated with poorer prognosis for patients diagnosed with conditions such as AIDS, cancer, and heart disease. For example, meta-analyses show depression to be a significant predictor of mortality among cardiac patients (Barth et al. 2004) whereas similar findings have been obtained for cancer patients with a 25% increased mortality rate for patients reporting even subclinical depressive symptoms (Satin et al. 2009). Relatedly, grief has been found to have significant health implications. "
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    ABSTRACT: Experiencing health problems can produce strong emotional responses that may impact psychological well-being and disease outcome. Also emotional states have been found to be associated with the development of disease. Negative emotions have been found to be associated with health complaints. Conversely, positive emotions have been found to be associated with better health. Emotions may affect health indirectly by influencing behaviors known to be associated with health outcomes or through physiological mechanisms such as physiological reactivity and changes in immune functioning. Approaches for helping people deal more effectively with negative emotions and maximize positive ones are discussed.
    International Encyclopedia of the Social & Behavioral Sciences, 2nd edition edited by James D Wright, 01/2015: chapter Emotions and health; Elsevier.
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