Symptom and course heterogeneity of depressive symptoms and prognosis following myocardial infarction.

Abstract

Objective: Previously published findings from the DepreMI cohort suggested that both the course and the type of depressive symptoms following myocardial infarction (MI) are related to prognosis, but did not examine both factors simultaneously. The aim of this re-analysis study was to assess whether MI patients can be empirically classified based on trajectories of cognitive/affective (CA) and somatic/affective (SA) symptoms, and whether these classes differentially predict adverse outcomes. Results: Three classes were identified: 'low severity': consistently low CA and SA (n=316); 'somatic persistence': consistently low CA and high SA (n=110); and 'overall persistence': high and increasing CA and SA (n=31). After adjustment for gender and the Global Registry of Acute Coronary Events risk score, somatic persistence (HR:1.86; 95% CI: 1.18-2.94; p=0.008), but not overall persistence (HR:1.09.; 95% CI: 0.39-3.03; p=0.87), predicted mortality compared with low severity. Classes were not predictive of non-fatal cardiovascular events.Conclusions: MI patient classes differed in severity and course of CA and SA depressive symptoms in the post-MI year. Only a class with persistent SA depressive symptoms was associated with increased mortality compared with patients with low severity. This is suggestive of different origins of SA depressive symptoms in MI patients that may explain the differential associations with mortality.

Tangled Up in Blue: Unraveling the Links Between Emotional Distress and Treatment Adherence in Type 2 Diabetes

“…Other recent studies similarly demonstrate an independent effect of somatic symptoms, rather than cognitive-affective symptoms, in predicting poor CVD outcomes (see, e.g., refs. 35, 36, and 37). Whether this pattern of findings reflects a unique effect of certain depressive symptoms, a particular depression “subtype,” or confounding with symptoms of physical illness is unclear.…”

Depression prevalence in cardiovascular disease: global systematic review and meta-analysis

“…They added that tools which consider somatic symptoms result in a higher depression rate compared with those which exclude such depressive symptoms 6. Accordingly, Roest et al noted that older women make up the majority of individuals with somatic depressive symptoms 30. Another common tool used in various studies was CES-D, which can simultaneously screen for both depression and anxiety disorders in cardiac adults with excellent sensitivity and reliability.…”

Association of the Interaction Between Smoking and Depressive Symptom Clusters With Coronary Artery Calcification: The CARDIA Study

“…Among patients with stable CVD followed for an average of 3 years, somatic symptoms, but not cognitive symptoms, were associated with 30% greater odds of recurrent myocardial infarction or sudden cardiac death (Martens, Hoen, Mittelhaeuser, de Jonge, & Denollet, 2010). In a recent study, CVD patients with persistent somatic depressive symptoms, compared to those with persistent total depressive symptoms, were at 86% greater risk of mortality (Roest, Wardenaar, & de Jonge, 2016). Fewer studies have evaluated the negative affect or anhedonia symptom clusters in relation to CVD, though some have also observed significant associations between these symptom clusters and cardiac outcomes (e.g., Davidson et al, 2010; Pelle et al, 2011).…”