Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction

Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
American heart journal (Impact Factor: 4.46). 07/2003; 146(1):48-54. DOI: 10.1016/S0002-8703(03)00083-8
Source: PubMed


Depression is common in patients with acute myocardial infarction (AMI) and is associated with adverse health outcomes. However, the extent to which clinical depression is related to comorbid medical conditions is unknown. This study examined the degree of association between clinical depression and medical comorbidity in patients hospitalized with AMI.
Two thousand four hundred and eighty-one depressed or socially isolated patients with AMI were enrolled, as part of the National Heart, Lung, and Blood Institute-sponsored Enhancing Recovery in Coronary Heart Disease clinical trial. A structured interview was used to diagnose major and minor depression and dysthymia; severity of depression was measured by the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Level of social support was measured by the ENRICHD Social Support Instrument. A modified version of the Charlson Comorbidity Index was used to measure the cumulative burden of medical comorbidity.
The adjusted odds ratios (ORs) for having major depression increased linearly with medical comorbidity (ORs 1.6, 2.2, 2.7 for each increasing medical comorbidity category). This relationship remained after adjusting for coronary heart disease severity (ORs 1.4, 1.7, 1.9, P <.001). The relationship between severity of depression and medical comorbidity was also maintained after excluding somatic symptoms of depression (F = 21.5, P <.0001).
Patients with AMI and clinical depression have significantly greater levels of medical comorbidity than nondepressed, socially isolated patients. Further research is needed to determine whether comorbid medical illness contributes to the more frequent rehospitalizations and increased risk of mortality associated with depression.

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    • "In general, depression is a relatively common disorder in older patients, and often occurs in the context of a physical impairment9. In a study by Watkins et al.10, the severity of depression correlated significantly with that of medical comorbity. Likewise, depression adversely influences the outcome of comorbid health disorders in the elderly11. "
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    ABSTRACT: Although rarely life threatening, dermatological diseases may have a considerable influence on a patient's quality of life and psychological well-being. As with morbidity and mental distress from other chronic diseases, a skin disorder can be the one of the main causes of depression in the geriatric population. To determine the prevalence of depression in elderly patients with dermatological disease in Korea and to identify factors associated with depression. Patients over the age of 60 years with dermatologic diseases were solicited for a questionnaire survey. The Geriatric Depression Scale (GDS) was used to obtain a patient-based measurement of depression. Additionally, demographic information and medical history were collected. The questionnaire was completed by 313 patients (39.94% men, mean age 69.04 years, mean disease duration 3.23 years). Dermatological disease overall had a significant effect on patients' depression (χ(2)=177.13, p<0.0001), with a mean GDS score of 12.35 (out of 30). The patients who had a GDS score greater than 10 was 62.3% which indicated increased prevalence of mild to severe depression when compared to the general population among whom only 22.22% percent have GDS score greater than 10. In the univariate analysis, physical health, education level, and the presence of concurrent diseases were risk factors for geriatric depression. However, we did not find any demographic or disease related variables that were independent predictors of depression. Geriatric patients with dermatological disease experience an increase burden of depression. Thus, it is important for clinicians to evaluate geriatric patients with dermatologic diseases for depression.
    Full-text · Article · Aug 2013 · Annals of Dermatology
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    • "Depressive symptoms alone also predict CHD risk, but stronger effect sizes have been observed for MDD compared to depressive mood, suggesting a dose-response relationship [31, 47, 48]. In addition to the enormous patient and caregiver burden, post-MI patients who are depressed have more medical comorbidities [49] and cardiac complications [50] and are at greater risk for mortality compared to nondepressed post-MI patients [16, 49–51]. Prospective observational studies show, among ACS patients, the hazard ratio associated with depressive symptoms is 1.80 (95% CI: 1.46–2.51) "
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    ABSTRACT: There are exciting findings in the field of depression and coronary heart disease. Whether diagnosed or simply self-reported, depression continues to mark very high risk for a recurrent acute coronary syndrome or for death in patients with coronary heart disease. Many intriguing mechanisms have been posited to be implicated in the association between depression and heart disease, and randomized controlled trials of depression treatment are beginning to delineate the types of depression management strategies that may benefit the many coronary heart disease patients with depression.
    Full-text · Article · Nov 2012
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    • "Therefore, in the present study, a dichotomized score for LVEF was used, which was dichotomized at 40% for DepreMI and at 45% for MIND-IT. An adapted version [15] of the Charlson Comorbidity Index [16] was calculated to assess a cumulative burden of somatic comorbidity. "
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    ABSTRACT: Background: Self-reported depressive symptoms and clinical depression after myocardial infarction (MI) are both associated with poor cardiac prognosis. It is important to distinguish between the two when assessing cardiac prognosis, but few studies have done so. The present article evaluates the independent prognostic impact of self-reported depressive symptoms and clinical depression on cardiac outcomes after MI. Methods: 2704 MI-patients were administered the Beck Depression Inventory (BDI) and underwent the Composite International Diagnostic Interview at 3 months post-MI. All-cause mortality, cardiac mortality and cardiovascular readmissions were evaluated up till 10 years post-MI (mean: 6 years), representing 16,783 persons-years of follow-up. Event-free survival was evaluated using Cox regression analysis. Results: Analyses on mortality and cardiovascular readmissions included 2493 and 2434 patients respectively. Compared to patients scoring <5 on the BDI, those scoring ≥ 19 had age- and sex-adjusted HR's (95% CI) of 3.20 (2.16-4.74, p<0.001) for all-cause mortality, 3.97 (2.06-7.65, p<0.001) for cardiac mortality, and 1.45 (1.08-1.95, p<0.05) for cardiovascular readmissions. Cardiac disease severity and cardiac risk factors explained one third to half of the relationship. The presence of clinical depression was associated with all-cause (HR: 1.72 (1.29-2.30, p<0.001)) and cardiac mortality (HR: 1.67 (1.01-2.77, p<0.05)). However, adjusting for BDI-scores decreased these HR's with 53% and 72% respectively, rendering them non-significant. Dichotomized BDI-scores remained to predict cardiac prognosis independently from the presence of clinical depression. Conclusions: After MI, self-reported depressive symptoms are a more accurate predictor of cardiac morbidity and mortality than clinical depression. This association is confounded largely by cardiac disease severity.
    Full-text · Article · Jul 2012 · International journal of cardiology
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