MAJOR DEPRESSION BEFORE AND AFTER MYOCARDIAL-INFARCTION - ITS NATURE AND CONSEQUENCES

The prevalence and prognostic impact of previous depression, depressio n in the hospital, and depression after discharge were studied in 222 patients admitted for acute myocardial infarction (MI). Patients were interviewed 1 week, 6 months, and 12 months after the index MI using a modified version of the Diagnostic Interview Schedule (DIS); patients also completed the Beck Depression Inventory (BDI). Patients or famil y members were recontacted at 18 months to determine survival. Some 27 .5% of patients had at least one episode of major depression before th eir MI, but only 7.7% were depressed at some point during the year pre ceding the infarct. Overall, 31.5% of patients experienced depression in the hospital or during the year postdischarge. Some 35 patients wer e depressed in the hospital, 30 became depressed between discharge and 6 months, and five more between 6 and 12 months after the MI. History of depression increased the risk of depression in the hospital and af ter discharge. Depression in the hospital was associated with an incre ased risk of mortality over 18 months. Patients who experienced a recu rrent depression in the hospital were at particularly high risk. Altho ugh patients who became depressed after discharge differed from those who remained depression-free in terms of age, history of depression, B DI scores, and the number of depression symptoms on the DIS in the hos pital, a model including these variables identified only 14.7% of the patients who became depressed after returning home. Post-MI depression is common and largely unrelated to medical and psychosocial factors.