Author/Authors :
Bagherian, Reza Department of Psychiatry - Isfahan University of Medical Scienses , Saneei, Hamid Department of Internal Medicine - School of Medicine - IUMS, Isfahan , Bahrami Ehsan, Hadi Department of Psychology - Tehran University of Medical Sciences
Abstract :
INTRODUCTION: Depression is common amongst post-myocardial infarction (MI)
patients and it has been associated with adverse clinical events in these patients. Post-MI
depression has also been shown to be an independent risk factor for mortality. However,
many questions about risk factors of post-MI depression remain unanswered. The
purpose of this study was to identify the medical and demographic predictors of post-MI
depression, in so far these are routinely available during MI hospitalization.
METHODS: 176 consecutive patients admitted to the CCU wards following MI were
selected based on the inclusion and exclusion criteria. Baseline measures were conducted
during hospitalization using a standardized history that included questions about
demographic characteristics and medical information, and all patients were underwent a
physical examination. Severity of MI index was assessed by a cardiologist using the Killip
Class. Also CPK levels were measured on admission and over the 2 subsequent days as
additional measures of the severity of MI. The diagnosis of depression (including major
and minor depression) at three months after MI was assessed using a standardized,
semistructured research interview by a psychiatrist and a clinical psychologist. This
interview provided DSM-IV diagnoses based on the patients’ psychiatric symptoms.
RESULTS: The findings showed that 46/6% suffered from post-MI depression three
months following MI. In multivariable analysis, beta-blocker (OR 2.987; CI 1.254-7.116),
history of depressive disorders (OR 2.838; CI 1.271-6.340), log max CPK (creatinine
phosphokinase value) (OR 2.410; CI 1.075-5.404), and age <60 (OR 2.652; CI 1.061-
6.626) were factors significantly associated with post-MI depression. This predictive
model also yielded 74.4% maximum predictive efficiency with 67.1% sensitivity and
80.9% specificity rates respectively, for differentiating those with and those without high
risk for developing post-MI depression. CONCLUSIONS: Beta-blocker, history of depressive disorders, log max CPK (creatinine
phosphokinase value), and age comprise demographic and medical predictors for post-
MI depressive symptoms. Thus, considering the above model, clinicians may able to
identify MI patients with a high risk for subsequent development of depression so that
these patients may be targeted for screening and potentially for psychosocial
intervention. The association found between depression and creatinine phosphokinase
(CPK) value begs the questions why two seemingly unrelated conditions should be
related, and what mediators or common biological pathways could link the two
phenomena.
Keywords :
Depression , myocardial infarction , demographic , medical predictors