Hostname: page-component-89b8bd64d-ktprf Total loading time: 0 Render date: 2026-05-09T23:49:46.500Z Has data issue: false hasContentIssue false
  • English
  • Français

Depressive symptom dimensions and cardiac prognosis following myocardial infarction: results from the ENRICHD clinical trial

Published online by Cambridge University Press:  20 June 2011

S. Bekke-Hansen ,
M. Trockel ,
M. M. Burg  and
C. Barr Taylor
S. Bekke-Hansen*
Affiliation:
Department of Psychology, Aarhus University, Aarhus, Denmark
M. Trockel
Affiliation:
Department of Psychiatry and Behavior Sciences, Stanford University, Stanford, CA, USA
M. M. Burg
Affiliation:
Columbia University Medical Center, New York, NY, USA Yale University Medical School, New Haven, CT, USA
C. Barr Taylor
Affiliation:
Department of Psychiatry and Behavior Sciences, Stanford University, Stanford, CA, USA
*
*Address for correspondence: S. Bekke-Hansen, M.Sc., Department of Psychology, Aarhus University, Jens Chr. Skous Vej 4, DK-8000 Aarhus, Denmark. (Email: sidsel@psy.au.dk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Depression following myocardial infarction (MI) independently increases risk for early cardiac morbidity and mortality. Studies suggest that somatic, but not cognitive, depressive symptoms are responsible for the increased risk. However, the effects of somatic depressive symptoms at follow-up, after sufficient time has elapsed to allow for physical recovery from the initial infarction, are not known. Our aim was to examine the relationship between cognitive and somatic depressive symptom dimensions at baseline and 12 months post-MI and subsequent mortality and cardiovascular morbidity.

Method

Patients were 2442 depressed and/or socially isolated men and women with acute MI included in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. We used principal components analysis (PCA) of the Beck Depression Inventory (BDI) items to derive subscales measuring cognitive and somatic depressive symptom dimensions, and Cox regression with Bonferroni correction for multiple testing to examine the contribution of these dimensions to all-cause mortality, cardiovascular mortality, and first recurrent non-fatal MI.

Results

After adjusting for medical co-morbidity and Bonferroni correction, the somatic depressive symptom dimension assessed proximately following MI did not significantly predict any endpoints. At 12 months post-MI, however, this dimension independently predicted subsequent all-cause [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.13–1.81] and cardiovascular mortality (HR 1.60, 95% CI 1.17–2.18). No significant associations were found between the cognitive depressive symptom dimension and any endpoints after Bonferroni correction.

Conclusions

Somatic symptoms of depression at 12 months post-MI in patients at increased psychosocial risk predicted subsequent mortality. Psychosocial interventions aimed at improving cardiac prognosis may be enhanced by targeting somatic depressive symptoms, with particular attention to somatic symptom severity at 12 months post-MI.

Keywords

Coronary heart diseasedepressionmortalitymyocardial infarctionprognosis

Information

Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 1 , January 2012 , pp. 51 - 60
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Barth, J, Schumacher, M, Herrmann-Lingen, C (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine 66, 802–813.CrossRefGoogle Scholar
Beck, AT, Steer, RA, Garbin, MG (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77–100.CrossRefGoogle Scholar
Berkman, LF, Blumenthal, J, Burg, M, Carney, RM, Catellier, D, Cowan, MJ, Czajkowski, SM, DeBusk, R, Hosking, J, Jaffe, A, Kaufmann, PG, Mitchell, P, Norman, J, Powell, LH, Raczynski, JM, Schneiderman, N; Enhancing Recovery in Coronary Heart Disease Patients Investigators (ENRICHD) (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. Journal of the American Medical Association 289, 3106–3116.Google ScholarPubMed
Costello, AB, Osborne, JW (2005). Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Practical Assessment, Research & Evaluation 10 (http://pareonline.net/pdf/v10n7.pdf).Google Scholar
Davidson, KW, Burg, MM, Kronish, IM, Shimbo, D, Dettenborn, L, Mehran, R, Vorchheimer, D, Clemow, L, Schwartz, JE, Lespérance, F, Rieckmann, N (2010). Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome. Archives of General Psychiatry 67, 480–488.CrossRefGoogle Scholar
de Jonge, P, Mangano, D, Whooley, MA (2007). 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, 735–739.CrossRefGoogle ScholarPubMed
de Jonge, P, Ormel, J, van den Brink, RH, van Melle, JP, Spijkerman, TA, Kuijper, A, van Veldhuisen, DJ, van den Berg, MP, Honig, A, Crijns, HJ, Schene, AH (2006 a). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry 163, 138–144.CrossRefGoogle ScholarPubMed
de Jonge, P, Rosmalen, JG, Kema, IP, Doornbos, B, van Melle, JP, Pouwer, F, Kupper, N (2010). Psychophysiological biomarkers explaining the association between depression and prognosis in coronary artery patients: a critical review of the literature. Neuroscience and Biobehavioral Reviews 35, 84–90.CrossRefGoogle ScholarPubMed
de Jonge, P, van den Brink, RH, Spijkerman, TA, Ormel, J (2006 b). Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events. Journal of the American College of Cardiology 48, 2204–2208.CrossRefGoogle ScholarPubMed
Dickens, C, McGowan, L, Percival, C, Tomenson, B, Cotter, L, Heagerty, A, Creed, F (2008). New onset depression following myocardial infarction predicts cardiac mortality. Psychosomatic Medicine 70, 450–455.CrossRefGoogle ScholarPubMed
ENRICHD Investigators (2000). Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD): study design and methods. American Heart Journal 139, 1–9.CrossRefGoogle Scholar
ENRICHD Investigators (2001 a). Enhancing Recovery in Coronary Heart Disease (ENRICHD) study intervention: rationale and design. Psychosomatic Medicine 63, 747–755.Google Scholar
ENRICHD Investigators (2001 b). Enhancing Recovery in Coronary Heart Disease (ENRICHD): baseline characteristics. American Journal of Cardiology 88, 316–322.CrossRefGoogle Scholar
Field, A (2009). Discovering Statistics Using SPSS, 3rd edn. SAGE Publications: London.Google Scholar
Forrester, AW, Lipsey, JR, Teitelbaum, ML, DePaulo, JR, Andrzejewski, PL (1992). Depression following myocardial infarction. International Journal of Psychiatry in Medicine 22, 33–46.CrossRefGoogle ScholarPubMed
Frasure-Smith, N, Lespérance, F, Talajic, M (1993). Depression following myocardial infarction: impact on 6-month survival. Journal of the American Medical Association 270, 1819–1825.CrossRefGoogle ScholarPubMed
Freedland, KE, Skala, JA, Carney, RM, Raczynski, JM, Taylor, CB, Mendes de Leon, CF, Ironson, G, Youngblood, ME, Krishnan, KR, Veith, RC; ENRICHD Investigators (2002). The Depression Interview and Structured Hamilton (DISH): rationale, development, characteristics, and clinical validity. Psychosomatic Medicine 64, 897–905.Google Scholar
Gillespie, CF, Nemeroff, CB (2005). Hypercortisolemia and depression. Psychosomatic Medicine 67, S26–S28.CrossRefGoogle Scholar
Gold, PW, Chrousos, GP (2002). Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. Molecular Psychiatry 7, 254–275.CrossRefGoogle ScholarPubMed
Grace, SL, Abbey, SE, Kapral, MK, Fang, J, Nolan, RP, Stewart, DE (2005). Effect of depression on five-year mortality after an acute coronary syndrome. American Journal of Cardiology 96, 1179–1185.CrossRefGoogle ScholarPubMed
Hoen, PW, Whooley, MA, Martens, EJ, Na, B, van Melle, JP, de Jonge, P (2010). Differential associations between specific depressive symptoms and cardiovascular prognosis in patients with stable coronary heart disease. Journal of the American College of Cardiology 56, 838–844.CrossRefGoogle Scholar
Jaffe, AS, Krumholz, HM, Catellier, DJ, Freedland, KE, Bittner, V, Blumenthal, JA, Calvin, JE, Norman, J, Sequeira, R, O'Connor, C, Rich, MW, Sheps, D, Wu, C; Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Trial Investigators (2006). Prediction of medical morbidity and mortality after acute myocardial infarction in patients at increased psychosocial risk in the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study. American Heart Journal 152, 126–135.CrossRefGoogle ScholarPubMed
Lett, HS, Blumenthal, JA, Babyak, MA, Sherwood, A, Strauman, T, Robins, C, Newman, MF (2004). Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosomatic Medicine 66, 305–315.Google ScholarPubMed
Linke, SE, Rutledge, T, Johnson, BD, Vaccarino, V, Bittner, V, Cornell, CE, Eteiba, W, Sheps, DS, Krantz, DS, Parashar, S, Bairey Merz, CN (2009). Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: a report from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation. Archives of General Psychiatry 66, 499–507.CrossRefGoogle ScholarPubMed
Martens, EJ, Hoen, PW, Mittelhaeuser, M, de Jonge, P, Denollet, J (2010). Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis. Psychological Medicine 40, 807–814.CrossRefGoogle ScholarPubMed
Nicholson, A, Kuper, H, Hemingway, H (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, 2763–2774.CrossRefGoogle Scholar
Roest, AM, Thombs, BD, Grace, SL, Stewart, DE, Abbey, SE, de Jonge, P (2011). Somatic/affective symptoms, but not cognitive/affective symptoms, of depression after acute coronary syndrome are associated with 12-month all-cause mortality. Journal of Affective Disorders 131, 158–163.CrossRefGoogle Scholar
Schiffer, AA, Pelle, AJ, Smith, OR, Widdershoven, JW, Hendriks, EH, Pedersen, SS (2009). Somatic versus cognitive symptoms of depression as predictors of all-cause mortality and health status in chronic heart failure. Journal of Clinical Psychiatry 70, 1667–1673.CrossRefGoogle ScholarPubMed
Schleifer, SJ, Macari-Hinson, MM, Coyle, DA, Slater, WR, Kahn, M, Gorlin, R, Zucker, HD (1989). The nature and course of depression following myocardial infarction. Archives of Internal Medicine 149, 1785–1789.CrossRefGoogle ScholarPubMed
Sheline, YI, Pieper, CF, Barch, DM, Welsh-Boehmer, K, McKinstry, RC, MacFall, JR, D'Angelo, G, Garcia, KS, Gersing, K, Wilkins, C, Taylor, W, Steffens, DC, Krishnan, RR, Doraiswamy, PM (2010). Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial. Archives of General Psychiatry 67, 277–285.CrossRefGoogle Scholar
Smolderen, KG, Spertus, JA, Reid, KJ, Buchanan, DM, Krumholz, HM, Denollet, J, Vaccarino, V, Chan, PS (2009). The association of cognitive and somatic depressive symptoms with depression recognition and outcomes after myocardial infarction. Circulation: Cardiovascular Quality and Outcomes 2, 328–337.Google ScholarPubMed
Takama, N, Kurabayashi, M (2009). Influence of untreated sleep-disordered breathing on the long-term prognosis of patients with cardiovascular disease. American Journal of Cardiology 103, 730–734.CrossRefGoogle ScholarPubMed
Tully, PJ, Winefield, HR, Baker, RA, Turnbull, DA, de Jonge, P (2011). Confirmatory factor analysis of the Beck Depression Inventory-II and the association with cardiac morbidity and mortality after coronary revascularization. Journal of Health Psychology 16, 584–595.CrossRefGoogle ScholarPubMed
van Melle, JP, de Jonge, P, Honig, A, Schene, AH, Kuyper, AM, Crijns, HJ, Schins, A, Tulner, D, van den Berg, MP, Ormel, J; MIND-IT investigators (2007). Effects of antidepressant treatment following myocardial infarction. British Journal of Psychiatry 190, 460–466.CrossRefGoogle ScholarPubMed
van Melle, JP, de Jonge, P, Spijkerman, TA, Tijssen, JG, Ormel, J, van Veldhuisen, DJ, van den Brink, RH, van den Berg, MP (2004). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosomatic Medicine 66, 814–822.CrossRefGoogle ScholarPubMed
Watkins, LL, Schneiderman, N, Blumenthal, JA, Sheps, DS, Catellier, D, Taylor, CB, Freedland, KE; ENRICHD Investigators (2003). Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction. American Heart Journal 146, 48–54.CrossRefGoogle ScholarPubMed