The effect of acute cardiovascular events on the risk of depression: What groups are vulnerable? Case-control study based on German health claims data

Depression and acute cardiovascular events (ACE) are widespread conditions that substantially contribute to morbidity and mortality worldwide. This study examines whether individuals who experienced an ACE are at higher risk of developing depression compared to those without ACE, and whether this risk differs by sex, age or income. An observational case-control design was employed using German statutory health claims data from 2015 to 2019 (N = 2,229,042). The study cohort included individuals diagnosed with ACE in 2016, with no prior depression or ACE history (N = 13,103). A control group was matched 1:1 by sex, age and income. Cox regression analyses estimated the risk of developing depression over three years, adjusting for comorbidities. Results are presented stratified by sex, age and income group. The analyses revealed that ACE exposure increased the risk of depression in both men and women across all age and income groups. This association was strongest in individuals under 55 years of age (hazard ratio [HR] = 2.09, 95 % CI: 1.40-3.13) and men with higher income (HR = 2.68, 95 % CI: 1.80-3.99). Furthermore, women had significantly higher risk of depression than men (HR = 1.58, 95 % CI: 1.38-1.80 in the study group and HR = 1.75, 95 % CI: 1.47-2.09 in the control group). The findings highlight the need to integrate mental health services for patients after ACE. Given depression's impact on rehospitalization, self-management, and mortality, routine screening for depressive symptoms in this population is strongly recommended.