Relative lack of depressive cognitions in post-myocardial infarction depression

Abstract

Background Depression has been associated with adverse clinical events in myocardial infarction (MI) patients, but many questions about the nature of post-MI depression remain unanswered. We examined whether depressive cognitions characteristic of depression in psychiatric patients are also present in post-MI patients with major depression (MD). Methods Non-depressed ( n = 40) and depressed ( n = 40) post-MI patients, and psychiatric outpatients ( n = 40) treated for clinical depression, matched on age and sex, were interviewed using a structured clinical interview to diagnose DSM-IV MD. All patients also completed the Beck Depression Inventory (BDI) and the Beck Cognition Checklist-Depression subscale (CCL-D). Results Mean levels of depressive cognitions were considerably higher in depressed psychiatric patients compared with depressed post-MI patients (34.9 versus 28.0; p = .013), and higher in depressed post-MI patients compared with non-depressed post-MI patients (28.0 versus 17.8; p < .0001), adjusted for age, sex, educational level, and marital status. Younger age ( p = .024), absence of a partner ( p = .016) and depressed psychiatric status ( p = .016) were independently associated with depressive cognitions. Psychiatric patients also had higher mean levels of depressive symptoms as compared to depressed post-MI patients (25.1 versus 17.8; p = .001). Limitations This study is based on a cross-sectional design. Conclusions The symptom presentation of MD in post-MI patients is both quantitatively and qualitatively different from that seen in psychiatric patients, suggesting that depressive symptoms in post-MI patients differ in content from those in psychiatric patients. These findings could have important consequences for the design and contents of therapeutic programs for treating depression in post-MI patients.