New onset depression
following MI: Time to
rethink the effects of
depression?
Dr Linda McGowan
Lecturer in Women’s Health
www.cuwai.com
What we already know…
• Depression has been shown to be independent
risk factor for mortality and morbidity post MI (up
to x 4)
• There is a dose-response relationship between
severity of depression and outcome
• Two systematic reviews confirm that depression
predicts a two-fold increase in all cause and
cardiac mortality in established CHD patients
(Barth et al., 2004; van Melle et al., 2004 )
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Is there a relationship?
• Not all studies confirm the relationship
between depression and mortality (e.g.
Dickens et al., 2004 Lane et al., 2001; Schleifer
et al., 1989)
• Many of these studies have robust
methodology
• Psychological interventions have failed to
have an effect on mortality (e.g. ENRICHD)
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Confounding factors
• How depression is measured
• Timing of the assessment
• Length of follow-up
• Severity of heart disease
• Co-morbid conditions
• Underlying physiological changes
• Unable to conclude the extent to which
depression predicts mortality
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What we did: The MIDAS Study
• Prospective cohort design
• Screened 1034 patients 3-4 days post MI
• Excluded: 380; Refused: 65
• Assessed 589 patients after MI
• Mean age: 60 yrs (11.1); Male – 414 (70.3%)
• Initial study: assessments at baseline & 12
months
Main outcomes: death from cardiac cause and
further cardiac events over 12 months
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Key Measures
Psychosocial
Physiological
• HADS
• Psychiatric
interview (SCAN)
• SF-36
• Social stress
(LEDS)
• Social support
• Illness beliefs
(IPQ)
• WHO criteria MI
• Severity of index MI
1.Killip class
2.CPKs
3.Medication on
discharge
4. Echocardiogram
(n=379)
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Initial findings
• No differences in mortality
• Lack of a close confidant, but not depression,
predicted further cardiac events
• Probably reflects improved treatment
• The association may be mediated by unhealthy
behaviours and lack of compliance
•