[Stressful life events and depressive disorders as risk factors for acute coronary heart disease]
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Published on: December 2, 2015
Chiara Rafanelli1, Leonardo Goffredo Pancaldi, Giulietta Ferranti
1Dipartimento di Psicologia, Università degli Studi, Bologna. chiara.rafanelli3@unibo.it
Insights
Recent life events significantly increase the risk of acute coronary heart disease. This highlights the importance of considering psychological factors alongside traditional cardiac risk factors for better patient outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Psychosomatic Medicine
Background:
- Stressful life events are implicated in coronary heart disease (CHD) pathogenesis.
- Depression, both clinical and subclinical, plays a role in myocardial infarction.
- The combined impact of recent life events, major depression, and depressive symptomatology on acute CHD onset requires further investigation.
Purpose of the Study:
- To investigate the association between recent life events, mood disorders, and the onset of first-episode coronary heart disease.
- To compare the frequency of life events and mood disorders in CHD patients versus healthy controls.
Main Methods:
- A case-control study included 97 patients with first-episode CHD and 97 matched healthy controls.
- Life events were assessed using Paykel's interview.
- Mood disorders (major depression, minor depression, demoralization) were diagnosed using semistructured interviews during remission from the acute phase.
Main Results:
- CHD patients reported significantly more life events than controls (p < 0.001).
- 30% of patients had major depressive disorder, 9% minor depression, and 20% demoralization.
- Life events were more frequent in CHD patients regardless of mood disorder status (p < 0.001).
Conclusions:
- Recent life events are strongly associated with acute coronary heart disease.
- These findings, alongside traditional risk factors, suggest potential clinical and prognostic implications.
- Further longitudinal studies are warranted to validate these associations.
Background:
Several studies outlined the role of stressful life events in the pathogenesis of coronary heart disease. It has recently been emphasized the role of depression, both clinical and subclinical, in the course of myocardial infarction. The relationship between recent life events, major depression, depressive symptomatology and onset of acute coronary heart disease has been less considered.
Methods:
Ninety-seven consecutive patients with first episode of coronary heart disease and 97 healthy subjects matched for sociodemographic variables were included. All patients were interviewed by Paykel's interview for recent life events, a semistructured interview for determining the psychiatric diagnosis of mood disorders, a semistructured interview for demoralization. Patients were assessed while on remission from the acute phase. The time period considered was the year preceding the first episode of coronary heart disease, and the year before interview for controls.
Results:
Patients with acute coronary heart disease reported significantly more life events than control subjects (p < 0.001). All categories of events (except entrance events) were significantly more frequent. Thirty percent of patients were identified as suffering from a major depressive disorder; 9% of patients were suffering from minor depression, and 20% from demoralization. Even though there was an overlap between major depression and demoralization (12%), 17% of patients with major depression were not classified as demoralized and 7 % of patients with demoralization did not satisfy the criteria for major depression. Independently of mood disorders, patients have a higher (p < 0.001) mean number of life events than controls. With regard to life events, the same significant difference (p < 0.001) compared to controls applied to patients with and without mood disorders.
Conclusions:
Our findings emphasize the relationship between life events and acute coronary heart disease. These data, together with those regarding traditional cardiac risk factors, may have clinical and prognostic implications to be verified in longitudinal studies.
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