Individual depressive symptoms and all-cause mortality In 6673 patients with myocardial infarction: Heterogeneity across age and sex subgroups

Ricardo de Miranda Azevedo; Annelieke M Roest; Robert M Carney; Kenneth E Freedland; Deirdre A Lane; Kapil Parakh; Peter de Jonge; Johan Denollet

doi:10.1016/j.jad.2017.11.025

Individual depressive symptoms and all-cause mortality In 6673 patients with myocardial infarction: Heterogeneity across age and sex subgroups

Ricardo de Miranda Azevedo^*, Annelieke M Roest, Robert M Carney, Kenneth E Freedland, Deirdre A Lane, Kapil Parakh, Peter de Jonge, Johan Denollet

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Depression predicts poor prognosis in patients with myocardial infarction (MI). However, individual depressive symptoms may have different prognostic value, and age and sex could be important effect modifiers. This study compared the prognostic value of individual depressive symptoms across age and sex subgroups in post-MI patients.

METHODS: Individual patient-data were compiled for 6673 post-MI patients from seven studies. Depressive symptoms were measured with 10 items of the Beck Depression Inventory (BDI10). The endpoint was all-cause mortality (mean=3.8 years). Multilevel multivariable Cox regression analysis was used to estimate the mortality risk across age groups (≤55, 56-69 and ≥70 years) and sex for symptoms that potentially interacted with age and sex.

RESULTS: At follow-up, 995 (15%) post-MI patients had died. BDI10 depression scores were associated with an increased mortality risk (HR:1.20;95%CI:1.11-1.28,p<.001). Negative self-image (HR:1.53;1.06-2.21;p=.022) and indecisiveness (HR:1.53;1.15-2.04;p=.003) were associated with increased mortality in men <55. Dissatisfaction was associated with increased mortality in men aged 56-69 (HR:1.35;1.07-1.71;p=. 011), and dissatisfaction (HR:1.34;1.10-1.63;p=.003) and fatigue (HR:1.45;1.20-1.74;p<.001) in men >70. Fatigue was associated with mortality in women aged 56-69 (HR:1.54;1.09-2.15;p=.012), and suicidal ideation in women aged >70 (HR:1.58;1.03-2.43;p=.037). Left-ventricular ejection fraction (LVEF) accounted for much of the associations in men ≤55 years and women ≥70 years.

LIMITATIONS: Findings are sample-specific and need replication in future research; BDI10 items were derived from the original BDI assessment.

CONCLUSIONS: There is large heterogeneity in the prognostic value of individual depressive symptoms in post-MI patients across sex and age subgroups. LVEF partially explained the depression-prognosis association in specific subgroups.

Original language	English
Pages (from-to)	178-185
Number of pages	8
Journal	Journal of Affective Disorders
Volume	228
DOIs	https://doi.org/10.1016/j.jad.2017.11.025
Publication status	Published - 1 Mar 2018
Externally published	Yes

Keywords

Age Distribution
Aged
Cause of Death
Depressive Disorder/diagnosis
Female
Humans
Male
Middle Aged
Myocardial Infarction/mortality
Prognosis
Psychiatric Status Rating Scales
Sex Distribution
Surveys and Questionnaires

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10.1016/j.jad.2017.11.025

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@article{b2e322c6674548e6bc6981d80c0ec2ed,

title = "Individual depressive symptoms and all-cause mortality In 6673 patients with myocardial infarction: Heterogeneity across age and sex subgroups",

abstract = "BACKGROUND: Depression predicts poor prognosis in patients with myocardial infarction (MI). However, individual depressive symptoms may have different prognostic value, and age and sex could be important effect modifiers. This study compared the prognostic value of individual depressive symptoms across age and sex subgroups in post-MI patients.METHODS: Individual patient-data were compiled for 6673 post-MI patients from seven studies. Depressive symptoms were measured with 10 items of the Beck Depression Inventory (BDI10). The endpoint was all-cause mortality (mean=3.8 years). Multilevel multivariable Cox regression analysis was used to estimate the mortality risk across age groups (≤55, 56-69 and ≥70 years) and sex for symptoms that potentially interacted with age and sex.RESULTS: At follow-up, 995 (15%) post-MI patients had died. BDI10 depression scores were associated with an increased mortality risk (HR:1.20;95%CI:1.11-1.28,p<.001). Negative self-image (HR:1.53;1.06-2.21;p=.022) and indecisiveness (HR:1.53;1.15-2.04;p=.003) were associated with increased mortality in men <55. Dissatisfaction was associated with increased mortality in men aged 56-69 (HR:1.35;1.07-1.71;p=. 011), and dissatisfaction (HR:1.34;1.10-1.63;p=.003) and fatigue (HR:1.45;1.20-1.74;p<.001) in men >70. Fatigue was associated with mortality in women aged 56-69 (HR:1.54;1.09-2.15;p=.012), and suicidal ideation in women aged >70 (HR:1.58;1.03-2.43;p=.037). Left-ventricular ejection fraction (LVEF) accounted for much of the associations in men ≤55 years and women ≥70 years.LIMITATIONS: Findings are sample-specific and need replication in future research; BDI10 items were derived from the original BDI assessment.CONCLUSIONS: There is large heterogeneity in the prognostic value of individual depressive symptoms in post-MI patients across sex and age subgroups. LVEF partially explained the depression-prognosis association in specific subgroups.",

keywords = "Age Distribution, Aged, Cause of Death, Depressive Disorder/diagnosis, Female, Humans, Male, Middle Aged, Myocardial Infarction/mortality, Prognosis, Psychiatric Status Rating Scales, Sex Distribution, Surveys and Questionnaires",

author = "{de Miranda Azevedo}, Ricardo and Roest, {Annelieke M} and Carney, {Robert M} and Freedland, {Kenneth E} and Lane, {Deirdre A} and Kapil Parakh and {de Jonge}, Peter and Johan Denollet",

year = "2018",

month = mar,

day = "1",

doi = "10.1016/j.jad.2017.11.025",

language = "English",

volume = "228",

pages = "178--185",

journal = "Journal of Affective Disorders",

issn = "0165-0327",

publisher = "Elsevier",

}

TY - JOUR

T1 - Individual depressive symptoms and all-cause mortality In 6673 patients with myocardial infarction

T2 - Heterogeneity across age and sex subgroups

AU - de Miranda Azevedo, Ricardo

AU - Roest, Annelieke M

AU - Carney, Robert M

AU - Freedland, Kenneth E

AU - Lane, Deirdre A

AU - Parakh, Kapil

AU - de Jonge, Peter

AU - Denollet, Johan

PY - 2018/3/1

Y1 - 2018/3/1

N2 - BACKGROUND: Depression predicts poor prognosis in patients with myocardial infarction (MI). However, individual depressive symptoms may have different prognostic value, and age and sex could be important effect modifiers. This study compared the prognostic value of individual depressive symptoms across age and sex subgroups in post-MI patients.METHODS: Individual patient-data were compiled for 6673 post-MI patients from seven studies. Depressive symptoms were measured with 10 items of the Beck Depression Inventory (BDI10). The endpoint was all-cause mortality (mean=3.8 years). Multilevel multivariable Cox regression analysis was used to estimate the mortality risk across age groups (≤55, 56-69 and ≥70 years) and sex for symptoms that potentially interacted with age and sex.RESULTS: At follow-up, 995 (15%) post-MI patients had died. BDI10 depression scores were associated with an increased mortality risk (HR:1.20;95%CI:1.11-1.28,p<.001). Negative self-image (HR:1.53;1.06-2.21;p=.022) and indecisiveness (HR:1.53;1.15-2.04;p=.003) were associated with increased mortality in men <55. Dissatisfaction was associated with increased mortality in men aged 56-69 (HR:1.35;1.07-1.71;p=. 011), and dissatisfaction (HR:1.34;1.10-1.63;p=.003) and fatigue (HR:1.45;1.20-1.74;p<.001) in men >70. Fatigue was associated with mortality in women aged 56-69 (HR:1.54;1.09-2.15;p=.012), and suicidal ideation in women aged >70 (HR:1.58;1.03-2.43;p=.037). Left-ventricular ejection fraction (LVEF) accounted for much of the associations in men ≤55 years and women ≥70 years.LIMITATIONS: Findings are sample-specific and need replication in future research; BDI10 items were derived from the original BDI assessment.CONCLUSIONS: There is large heterogeneity in the prognostic value of individual depressive symptoms in post-MI patients across sex and age subgroups. LVEF partially explained the depression-prognosis association in specific subgroups.

AB - BACKGROUND: Depression predicts poor prognosis in patients with myocardial infarction (MI). However, individual depressive symptoms may have different prognostic value, and age and sex could be important effect modifiers. This study compared the prognostic value of individual depressive symptoms across age and sex subgroups in post-MI patients.METHODS: Individual patient-data were compiled for 6673 post-MI patients from seven studies. Depressive symptoms were measured with 10 items of the Beck Depression Inventory (BDI10). The endpoint was all-cause mortality (mean=3.8 years). Multilevel multivariable Cox regression analysis was used to estimate the mortality risk across age groups (≤55, 56-69 and ≥70 years) and sex for symptoms that potentially interacted with age and sex.RESULTS: At follow-up, 995 (15%) post-MI patients had died. BDI10 depression scores were associated with an increased mortality risk (HR:1.20;95%CI:1.11-1.28,p<.001). Negative self-image (HR:1.53;1.06-2.21;p=.022) and indecisiveness (HR:1.53;1.15-2.04;p=.003) were associated with increased mortality in men <55. Dissatisfaction was associated with increased mortality in men aged 56-69 (HR:1.35;1.07-1.71;p=. 011), and dissatisfaction (HR:1.34;1.10-1.63;p=.003) and fatigue (HR:1.45;1.20-1.74;p<.001) in men >70. Fatigue was associated with mortality in women aged 56-69 (HR:1.54;1.09-2.15;p=.012), and suicidal ideation in women aged >70 (HR:1.58;1.03-2.43;p=.037). Left-ventricular ejection fraction (LVEF) accounted for much of the associations in men ≤55 years and women ≥70 years.LIMITATIONS: Findings are sample-specific and need replication in future research; BDI10 items were derived from the original BDI assessment.CONCLUSIONS: There is large heterogeneity in the prognostic value of individual depressive symptoms in post-MI patients across sex and age subgroups. LVEF partially explained the depression-prognosis association in specific subgroups.

KW - Age Distribution

KW - Aged

KW - Cause of Death

KW - Depressive Disorder/diagnosis

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/mortality

KW - Prognosis

KW - Psychiatric Status Rating Scales

KW - Sex Distribution

KW - Surveys and Questionnaires

U2 - 10.1016/j.jad.2017.11.025

DO - 10.1016/j.jad.2017.11.025

M3 - Article

C2 - 29253684

SN - 0165-0327

VL - 228

SP - 178

EP - 185

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -

Individual depressive symptoms and all-cause mortality In 6673 patients with myocardial infarction: Heterogeneity across age and sex subgroups

Abstract

Keywords

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