Depression and anxiety as predictors of outcome after myocardial infarction

Objective: The objective of this study was to investigate the significance of emotional distress immediately after a myocardial infarction as a predic tor of physical, psychological, and social outcomes and resource use, Metho ds: In an epidemiological survey, demographic and cardiological data were o btained for all patients from a defined geographical area who had had a myo cardial infarction (according to diagnostic criteria of tho Monitoring Tren ds and Determinants in Cardiovascular Disease [MONICA] trial). Hospital sur vivors were interviewed and were asked to complete self-report assessments on mental state and quality of life. Full replies were available at baselin e for 347 subjects. Self-report follow-up questionnaire information was col lected 3 months and 1 year later. Results: Fifteen percent of patients scor ed as probable cases of anxiety or depression. They were more likely than n oncases to report preinfarct distress and poor adjustment (as indicated on the 36-item Medical Outcome Study short form). There was an improvement at 3 months, but there was little overall or individual change after that rime . Anxiety and depression did not predict subsequent mortality but did signi ficantly predict poor outcome at 1 year on all dimensions Df the 36-item sh ort form quality-of-life measure and on specific measures of everyday activ ity and reports of chest pain, use of primary care resources; and secondary prevention lifestyle changes. Conclusions: Subjects who are distressed in the hospital are at high risk of adverse psychological and quality-of-life outcomes during the ensuing year. Our findings strengthen the argument for in-hospital identification and treatment of patients with depression and an xiety after myocardial infarction.