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Published on: May 22, 2019
Components of depression and 6-year mortality after an acute coronary syndrome
Peter Herbison1, Charles LokHui Tie2, EngWei Tang2
1Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Insights
Post-myocardial infarct depression symptoms impact long-term survival. Somatic symptoms, not cognitive ones, showed a potential link to mortality in acute coronary syndrome patients, though not statistically significant.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Depression following myocardial infarction presents with both somatic and cognitive symptoms.
- The distinct impact of these symptom types on long-term patient survival remains incompletely understood.
Purpose of the Study:
- To investigate the differential relationship between somatic and cognitive depressive symptoms and 6-year mortality in patients with acute coronary syndrome.
- To assess the predictive value of the Beck Depression Inventory-II (BDI-II) somatic and cognitive subscales on mortality.
Main Methods:
- A cohort of 277 patients with acute coronary syndrome was assessed using the Beck Depression Inventory-II (BDI-II) in 2005.
- Six-year mortality data were collected, and statistical models were used to analyze the association between BDI-II scores (total, somatic, and cognitive) and mortality, controlling for baseline characteristics.
Main Results:
- Overall BDI-II scores did not significantly predict 6-year mortality.
- Somatic depressive symptoms showed a trend towards predicting mortality (OR, 1.10; 95% CI, 1.01-1.20), while cognitive symptoms did not (OR, 1.01; 95% CI, 0.96-1.08).
- These associations attenuated after adjusting for age, sex, and Global Registry of Acute Coronary Events score.
Conclusions:
- In patients with acute coronary syndrome, higher baseline BDI-II scores, particularly somatic symptoms, were associated with increased mortality, though not reaching statistical significance.
- The findings suggest a potential, albeit weak, link between somatic depressive symptoms and long-term survival in this population.
Background:
Post-myocardial infarct depression includes both somatic depressive symptoms and nonsomatic cognitive symptoms. Their respective relationships to long-term survival are unclear.
Methods:
Depression was diagnosed by measuring the Beck Depression Inventory-II (BDI-II) on consecutive patients who presented with acute coronary syndrome in 2005. Six-year mortality data were extracted from the National Health Index. This study investigated whether mortality was related to the somatic or cognitive elements of the BDI-II score, controlling for baseline characteristics including the Global Registry of Acute Coronary Events score. The BDI-II, somatic, and cognitive scores were treated as continuous variables.
Results:
Of the 277 patients, 52 died over 6 years. Higher BDI-II score did not predict mortality at 6 years (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.98-1.06). In the Cognitive/Affective-Somatic model, somatic depressive symptoms (OR, 1.10; 95% CI, 1.01-1.20) predicted all-cause mortality, but cognitive/affective depressive symptoms (OR, 1.01; 95% CI, 0.96-1.08) did not. This association attenuated after controlling for age and sex (OR, 1.10; 95% CI, 0.99-1.22), and age, sex, and Global Registry of Acute Coronary Events score (OR, 1.09; 95% CI, 0.99-1.21). Results from the Somatic/Affective-Cognitive model did not reach statistical significance. Differences were small and unlikely to be of clinical importance.
Conclusions:
In patients with acute coronary syndrome, those who died had a higher baseline BDI-II score, particularly somatic score, although this did not reach statistical significance.
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