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Depression and long-term mortality risk in patients with coronary artery disease
J C Barefoot1, M J Helms, D B Mark
1Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina 27710, USA.
Insights
Depression significantly increases long-term mortality risk in coronary artery disease (CAD) patients. Even mild depression elevates cardiac and total mortality, underscoring the need for sustained mental health support in cardiac care.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Patients with coronary artery disease (CAD) face elevated mortality risk when depressed.
- Prior studies on depression and CAD mortality had limited follow-up durations.
Purpose of the Study:
- To investigate the long-term association between depression and mortality in patients with established coronary artery disease (CAD).
Main Methods:
- 1,250 CAD patients were assessed for depression using the Zung Self-Rating Depression Scale (SDS).
- Participants were followed for mortality outcomes for up to 19.4 years.
- Statistical analyses controlled for initial disease severity and treatment interventions.
Main Results:
- Higher SDS scores correlated with increased cardiac death (p = 0.002) and total mortality (p < 0.001).
- Moderate to severe depression was linked to a 69% higher odds of cardiac death and 78% higher odds of all-cause mortality.
- Elevated mortality risk persisted beyond 5 and 10 years post-hospitalization for depressed patients.
Conclusions:
- Depression is a significant long-term predictor of mortality in CAD patients.
- The persistent risk suggests depression may be chronic or recurrent, potentially worsening CAD progression or triggering events.
- Interventions addressing depression in CAD patients are crucial for improving long-term outcomes.
Abstract:
Previous research has established that patients with coronary artery disease (CAD) have an increased risk of death if they are depressed at the time of hospitalization. Follow-up periods have been short in these studies; therefore, the present investigation examined this phenomenon over an extended period of time. Patients with established CAD (n = 1,250) were assessed for depression with the Zung Self-Rating Depression Scale (SDS) and followed for subsequent mortality. Follow-up ranged up to 19.4 years. SDS scores were associated with increased risk of subsequent cardiac death (p = 0.002) and total mortality (p < 0.001) after controlling for initial disease severity and treatment. Patients with moderate to severe depression had a 69% greater odds of cardiac death and a 78% greater odds of mortality from all causes than nondepressed patients. Increased risk was not confined to the initial months after hospitalization. Patients with high SDS scores at baseline still had a higher risk of cardiac death > 5 years later (p < 0.005). Compared with the nondepressed, patients with moderate to severe depression had an 84% greater risk 5 to 10 years later and a 72% greater risk after > 10 years. Patients with mild depression had intermediate levels of risk in all models. The heightened long-term risk of depressed patients suggests that depression may be persistent or frequently recurrent in CAD patients and is associated with CAD progression, triggering of acute events, or both.