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Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis

Jürgen Barth1, Martina Schumacher, Christoph Herrmann-Lingen

  • 1Department of Rehabilitation Psychology, Institute of Psychology, University of Freiburg, Germany. mail@juergen-barth.de

Psychosomatic Medicine
|November 27, 2004
PubMed

Insights

Depression significantly increases mortality risk in coronary heart disease (CHD) patients. Both depressive symptoms and clinical depression are linked to higher death rates, emphasizing depression as a key risk factor in CHD care.

Area of Science:

  • Cardiology
  • Psychiatry
  • Epidemiology

Background:

  • Prospective studies link depression to increased coronary heart disease (CHD) risk in healthy individuals.
  • The relative risk for any CHD event in depressed individuals is 1.64.
  • The impact of depression on CHD patients' mortality has not been meta-analyzed.

Purpose of the Study:

  • To quantify the impact of depressive symptoms or disorders on cardiac and all-cause mortality in CHD patients.
  • To analyze the strength and time dependency of this relationship.
  • To compare the predictive value of depressive symptoms versus clinical depression diagnosis.

Main Methods:

  • A meta-analysis of prospective cohort studies published in English and German from 1980 to 2003.
  • Searched databases included Medline, PsycInfo, and PSYNDEX.
  • A random model was used to estimate combined effects (odds ratios or adjusted hazard ratios).

Main Results:

  • Depressive symptoms significantly increase mortality risk in CHD patients, with a two-fold higher risk within 2 years (OR, 2.24).
  • This increased risk persists long-term (OR, 1.78) and after adjusting for other risk factors (HR [adj], 1.76).
  • Clinical depression also elevates mortality risk, especially after 2 years (OR, 2.61).

Conclusions:

  • Both depressive symptoms and clinical depression are unfavorable prognostic factors for mortality in CHD patients.
  • Depression should be considered a relevant risk factor in managing CHD.
  • Further research is needed to clarify the predictive precision of self-report versus clinical interview methods.
Abstract

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