Risk factors for incident depression in patients at first acute coronary syndrome

Paolo Ossola,Francesca Paglia,Annalisa Pelosi,Chiara De Panfilis,Giulio Conte,Matteo Tonna,Diego Ardissino,Carlo Marchesi

doi:10.1016/j.psychres.2015.05.063

Paolo Ossola, Francesca Paglia + Show 6 more

Open Access

https://doi.org/10.1016/j.psychres.2015.05.063

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Journal: Psychiatry Research	Publication Date: Jun 27, 2015
Citations: 53	License type: cc-by

Affiliation: University of Parma

Abstract

The association between depression and acute coronary syndrome (ACS) is well-established and the first seems to impact meaningfully on cardiac prognosis. Nonetheless only a few studies have evaluated the relationship between incident depression, defined as new cases in patients with no history of depression, and ACS. Therefore the aim of this study is to analyse the risk factors of incident depression in a sample of patients who were presenting their first ACS. 304 consecutive patients were recruited. The presence of major (MD) and minor (md) depression was assessed with the Primary Care Evaluation of Mental Disorders (PRIME-MD), whereas its severity was evaluated with the Hospital Anxiety and Depression Scale (HADS). Evaluations were collected both at baseline and at 1, 2, 4, 6, 9 and 12 month follow ups. Out of 304 subjects (80.6% males), MD was diagnosed in 15 (4.9%) and md in 25 patients (8.2%). At baseline risk factors for a post-ACS depressive disorder were being women (MD only), widowed (md only) and having mild anhedonic depressive symptoms few days after the ACS. Clinicians should keep in mind these variables when facing a patient at his/her first ACS, given the detrimental effect of depression on cardiac prognosis.

Highlights

Cardiac condition at the enrolment were presenting for the first time with symptoms suggestive of an acute coronary syndrome and in whom a ST-segment elevation myocardial infarction (STEMI), a non-ST-segment elevation myocardial infarction (NSTEMI), or unstable angina had been diagnosed (Van deWerf et al, 2008; Hamm et al, 2011)
Since a high correlation has been found between Hospital Anxiety and Depression Scale (HADS)-A and HADS-D (r 1⁄4.777, p o0.001) we tested the collinearity between the predictors and all the Tolerance Values were higher than 0.01 (Menard, 1995) and VIF Values smaller than 10 (Myers, 1990), with no huge differences in the Condition Indexes
The present study found that among patients experiencing their first acute coronary syndrome (ACS), women, widowed and those with loss of positive affectivity and anxiety a few days after the ACS, were at higher risk of suffering incident depression

Summary

Introduction

The severity of the ACS has been proposed as another risk factor for developing depression; this association was found by some authors (van Melle et al, 2006; Frasure-Smith et al, 1999; de Jonge et al, 2006) and not by others (Lane et al, 2005; Lett et al, 2008) Strik et al, 2001; Rieckmann et al, 2006; Stafford et al, 2009; Doyle et al, 2011; Denton et al, 2012) and the presence of depressive symptoms in the few days after an ACS (Di Benedetto et al, 2007; Celano et al, 2012; Marchesi et al, 2014a).

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