N. Frasuresmith et al., DEPRESSION FOLLOWING MYOCARDIAL-INFARCTION - IMPACT ON 6-MONTH SURVIVAL, JAMA, the journal of the American Medical Association, 270(15), 1993, pp. 1819-1825
Objective.-To determine if the diagnosis of major depression in patien
ts hospitalized following myocardial infarction (MI) would have an ind
ependent impact on cardiac mortality over the first 6 months after dis
charge. Design.-Prospective evaluation of the impact of depression ass
essed using a modified version of the National Institute of Mental Hea
lth Diagnostic Interview Schedule for major depressive episode. Cox pr
oportional hazards regression was used to evaluate the independent imp
act of depression after control for significant clinical predictors in
the data set. Setting.-A large, university-affiliated hospital specia
lizing in cardiac care, located in Montreal, Quebec. Patients.-All con
senting patients (N=222) who met established criteria for MI between A
ugust 1991 and July 1992 and who survived to be discharged from the ho
spital. Patients were interviewed between 5 and 15 days following the
MI and were followed up for 6 months. There were no age limits (range,
24 to 88 years; mean, 60 years). The sample was 78% male. Primary Out
come Measure.-Survival status at 6 months. Results.-By 6 months, 12 pa
tients had died. All deaths were due to cardiac causes. Depression was
a significant predictor of mortality (hazard ratio, 5.74; 95% confide
nce interval, 4.61 to 6.87; P=.0006). The impact of depression remaine
d after control for left ventricular dysfunction (Killip class) and pr
evious MI, the multivariate significant predictors of mortality in the
data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14
to 5.44; P=.013). Conclusion.-Major depression in patients hospitalize
d following an MI is an independent risk factor for mortality at 6 mon
ths. Its impact is at least equivalent to that of left ventricular dys
function (Killip class) and history of previous MI. Additional study i
s needed to determine whether treatment of depression can influence po
st-MI survival and to assess possible underlying mechanisms.