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Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis

  • E. J. Martens (a1) (a2), P. W. Hoen (a3), M. Mittelhaeuser (a1), P. de Jonge (a1) (a3) and J. Denollet (a1)
  • DOI:
  • Published online: 20 August 2009

Individual symptoms of post-myocardial infarction (MI) depression may be differentially associated with cardiac prognosis, in which somatic/affective symptoms appear to be associated with a worse cardiovascular prognosis than cognitive/affective symptoms. These findings hold important implications for treatment but need to be replicated before conclusions regarding treatment can be drawn. We therefore examined the relationship between depressive symptom dimensions following MI and both disease severity and prospective cardiac prognosis.


Patients (n=473) were assessed on demographic and clinical variables and completed the Beck Depression Inventory (BDI) within the first week of hospital admission for acute MI. Depressive symptom dimensions were associated with baseline left ventricular ejection fraction (LVEF) and prospective cardiac death and/or recurrent MI. The average follow-up period was 2.8 years.


Factor analysis revealed two symptom dimensions – somatic/affective and cognitive/affective – in the underlying structure of the BDI, identical to previous results. There were 49 events attributable to cardiac death (n=23) or recurrent MI (n=26). Somatic/affective (p=0.010) but not cognitive/affective (p=0.153) symptoms were associated with LVEF and cardiac death/recurrent MI. When controlling for the effects of previous MI and LVEF, somatic/affective symptoms remained significantly predictive of cardiac death/recurrent MI (hazard ratio 1.31, 95% confidence interval 1.02–1.69, p=0.038). Previous MI was also an independent predictor of cardiac death/recurrent MI.


We confirmed that somatic/affective, rather than cognitive/affective, symptoms of depression are associated with MI severity and cardiovascular prognosis. Interventions to improve cardiovascular prognosis by treating depression should be targeted at somatic aspects of depression.

Corresponding author
*Address for correspondence: E. J. Martens, Ph.D., CoRPS, Department of Medical Psychology, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LETilburg, The Netherlands. (Email:
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KA Barbour , TM Edenfield , JA Blumenthal (2007). Exercise as a treatment for depression and other psychiatric disorders: a review. Journal of Cardiopulmonary Rehabilitation and Prevention 27, 359367.

J Barth , M Schumacher , C Herrmann-Lingen (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine 66, 802813.

AT Beck , CH Ward , M Mendelson , J Mock , J Erbaugh (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.

RM Carney , KE Freedland , AS Jaffe , N Frasure-Smith , F Lesperance , DS Sheps , AH Glassman , CM O'Connor , JA Blumenthal , PG Kaufmann , SM Czajkowski (2004). Depression as a risk factor for post-MI mortality. Journal of the American College of Cardiology 44, 472474.

KW Davidson , DJ Kupfer , JT Bigger , RM Califf , RM Carney , JC Coyne , SM Czajkowski , E Frank , N Frasure-Smith , KE Freedland , ES Froelicher , AH Glassman , WJ Katon , PG Kaufmann , RC Kessler , HC Kraemer , KR Krishnan , F Lesperance , N Rieckmann , DS Sheps , JM Suls (2006). Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report. Psychosomatic Medicine 68, 645650.

P De Jonge , J Denollet , JP van Melle , A Kuyper , A Honig , AH Schene , J Ormel (2007 a). Associations of type D personality and depression with somatic health in myocardial infarction patients. Journal of Psychosomatic Research 63, 477482.

P De Jonge , D Mangano , MA Whooley (2007 b). Differential association of cognitive and somatic depressive symptoms with heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. Psychosomatic Medicine 69, 735739.

P De Jonge , J Ormel , RH van den Brink , JP van Melle , TA Spijkerman , A Kuijper , DJ van Veldhuisen , MP van den Berg , A Honig , HJ Crijns , AH Schene (2006). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry 163, 138144.

N Frasure-Smith , F Lesperance , M Talajic (1995). Depression and 18-month prognosis after myocardial infarction. Circulation 91, 999–1005.

AH Glassman , CM O'Connor , RM Califf , K Swedberg , P Schwartz , JT Bigger Jr., KR Krishnan , LT van Zyl , JR Swenson , MS Finkel , C Landau , PA Shapiro , CJ Pepine , J Mardekian , WM Harrison , D Barton , M Mclvor (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. Journal of the American Medical Association 288, 701709.

M Hamilton (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.

K Kroenke , RL Spitzer , JB Williams (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613.

D Lane , D Carroll , GY Lip (2003). Anxiety, depression, and prognosis after myocardial infarction: is there a causal association? Journal of the American College of Cardiology 42, 18081810.

D Lane , D Carroll , C Ring , DG Beevers , GY Lip (2001). Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety. Psychosomatic Medicine 63, 221230.

F Lespérance , N Frasure-Smith , D Koszycki , MA Laliberte , LT van Zyl , B Baker , JR Swenson , K Ghatavi , BL Abramson , P Dorian , MC Guertin (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. Journal of the American Medical Association 297, 367379.

F Lespérance , N Frasure-Smith , M Talajic , MG Bourassa (2002). Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation 105, 10491053.

H Lett , S Ali , M Whooley (2008). Depression and cardiac function in patients with stable coronary heart disease: findings from the Heart and Soul Study. Psychosomatic Medicine 70, 444449.

A Nicholson , H Kuper , H Hemingway (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal 27, 27632774.

KG Smolderen , JA Spertus , KJ Reid , DM Buchanan , HM Krumholz , J Denollet , V Vaccarino , PS Chan (2009). The association of cognitive and somatic depressive symptoms with depression recognition and outcomes after myocardial infarction. Circulation: Cardiovascular Quality and Outcomes 2, 328337.

C Sørensen , E Friis-Hasché , T Haghfelt , P Bech (2005). Postmyocardial infarction mortality in relation to depression: a systematic critical review. Psychotherapy and Psychosomatics 74, 6980.

BD Thombs , SL Grace , RC Ziegelstein (2006). Do symptom dimensions of depression following myocardial infarction relate differently to physical health indicators and cardiac prognosis? American Journal of Psychiatry 163, 12951296.

JP Van Melle , P de Jonge , A Honig , AH Schene , AM Kuyper , HJ Crijns , A Schins , D Tulner , MP van den Berg , J Ormel (2007). Effects of antidepressant treatment following myocardial infarction. British Journal of Psychiatry 190, 460466.

JP Van Melle , P de Jonge , J Ormel , HJ Crijns , DJ van Veldhuisen , A Honig , AH Schene , MP van den Berg (2005). Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND-IT. European Heart Journal 26, 26502656.

JP Van Melle , P de Jonge , TA Spijkerman , JG Tijssen , J Ormel , DJ van Veldhuisen , RH van den Brink , MP van den Berg (2004). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosomatic Medicine 66, 814822.

LL Watkins , N Schneiderman , JA Blumenthal , DS Sheps , D Catellier , CB Taylor , KE Freedland (2003). Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction. American Heart Journal 146, 4854.

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