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Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction

  • Chris M. Dickens (a1), Linda McGowan (a1), Carol Percival (a1), Barbara Tomenson (a1), Lawrence Cotter (a2), Anthony Heagerty (a2) and Francis H. Creed (a3)...
Abstract
Background

The extent to which depression impairs health-related quality of life (HRQoL) in the physically ill has not been clearly established.

Aims

To quantify the adverse influence of depression and anxiety assessed at the time of first myocardial infarction and 6 months later, on the physical aspect of HRQoL 12 months after the infarction.

Method

In all, 260 in-patients, admitted following first myocardial infarction, completed the Hospital Anxiety and Depression Scale and the Medical Outcomes Study SF–36 assessment before discharge and at 6- and 12-month follow-up.

Results

Depression and anxiety 6 months after myocardial infarction predicted subsequent impairment in the physical aspects of HRQoL (attributable adjusted R 2=9%, P<0.0005). These negative effects of depression and anxiety on outcome were mediated by feelings of fatigue. Depression and anxiety present before myocardial infarction did not predict HRQoL 12 months after myocardial infarction.

Conclusions

Detection and treatment of depression and anxiety following myocardial infarction improve the patient's health-related quality of life.

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Copyright
Corresponding author
Chris Dickens, Department of Psychiatry, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester MI3 9WL, UK. Tel: +44 (0) 161 276 5386; fax: +44 (0) 161 273 2135; email: chris.dickens@manchester.ac.uk
Footnotes
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Declaration of interest

F.H.C. has performed consultancy work for Ely Lilly in a field unconnected with the current study. There are no other conflicts of interest to declare.

Footnotes
References
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Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction

  • Chris M. Dickens (a1), Linda McGowan (a1), Carol Percival (a1), Barbara Tomenson (a1), Lawrence Cotter (a2), Anthony Heagerty (a2) and Francis H. Creed (a3)...
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eLetters

CONCLUSION OR HYPOTHESIS

AMIT MALIK, Senior House Officer
01 February 2007

We read the Dickens et al paper with great interest.

The authors have clarified that this was an observational study and participants did not receive antidepressants. People with severe mental illness were excluded from the study. We felt that a proportion of the participants would be in need of antidepressants. The paper does not mention if antidepressants were commenced or not by the treating physicians (not researchers). The above point is quite important from ethical point of view. If some were put on the antidepressants how this group was treated by the researchers for the purpose of this study.

The use of scales in the immediate post Myocardial infarction as baseline (average 3.6 days after admission) might not be very appropriate as patients were physically unwell. Poor physical health might color theirviews about mental health in the week preceding the infarct. The authors have used baseline scores to arrive at important conclusions. They have found that depression and anxiety that preceded myocardial infarction did not predict impairment in HRQoL 12 months following infarction.

The hypothesis in the study that depression and anxiety contribute toimpaired health related quality of life following myocardial infarction appears quite true on face value. We feel that quantifying this contribution as authors attempted to do is quite difficult as the scales used to measure quality of life are highly subjective.

The authors using multiple regression statistics are able to demonstrate that depression and anxiety following myocardial infarction predict impairment in HRQoL 12 months following infarction. It would be a reasonable assumption, as authors’ state, that detection and treatment of depression and anxiety in the post MI period will improve health related quality of life. However in the brief summary of the paper at the beginning, the conclusion appears to suggest that detection and treatment of depression and anxiety in the post MI period will improve health related quality of life. This is an indirect inference from the findings of the study. It appears more as hypothesis rather than conclusion, which needs to be proved in a robust clinical trial.
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Conflict of interest: None Declared

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