Mild to moderate levels of depressive symptoms as characterized by Beck Dep
ression Inventory (BDI) scores of greater than or equal to 10 are associate
d with decreased survival after acute myocardial infarction (AMI). We inves
tigated whether lower levels of depressive symptoms are also associated wit
h increased mortality risk after AMI. We prospectively studied 285 patients
with AMI who survived to discharge for evidence, at the time of hospitaliz
ation, Of a DSM-IIIR mood disorder (using a structured clinical interview)
and for symptoms of depression (using the BDI). The overall mortality rate
at 4 months was 6.7%. Multiple logistic regression (chi-square 35.79, p les
s than or equal to 0.001) revealed that the independent predictors of morta
lity were: age greater than or equal to 65 years, left ventricular ejection
fraction < 35%, diabetes mellitus, and any depression (DSM-IIIR mood disor
der or BDI : 10) present at the time of AML Among patients :65 years old wi
th left ventricular ejection fraction < 35%, the 4-month mortality was 12%.
However, in this some group, those with any depression at the time of AMI
had a 4-month mortality of 50% (relative risk 4.1, p = 0.01). Among patient
s aged :65 years, the mortality according to BDI scale grouping 0 to 3, 4 t
o 9, and 10+ was 2.6%, 17.1%, and 23.3%, respectively (p < 0.002). Highest
mortality rates were observed in patients with most severe depressive sympt
oms. However, compared with those without depression, higher mortality was
also observed at very low levels of depressive symptoms (BDI 4 to 9) not ge
nerally considered clinically significant and below the level usually consi
dered predictive of increased post-AMI mortality. (C) 2001 by Excerpta Medi
ca, Inc.