Published online before print April 25, 2009, doi: 10.1161/CIRCOUTCOMES.109.868588
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Original Articles |
The Association of Cognitive and Somatic Depressive Symptoms With Depression Recognition and Outcomes After Myocardial Infarction
From the Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology (K.G.S., J.D.), Tilburg University, Tilburg, The Netherlands; the Mid America Heart Institute (J.A.S., K.J.R., D.M.B., P.S.C.), Kansas City, Mo; the University of Missouri–Kansas City (J.A.S., P.S.C.), Kansas City, Mo; the Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.), the Section of Health Policy and Administration, Department of Epidemiology and Public Health (H.M.K.), Yale University School of Medicine, and the Center for Outcomes Research and Evaluation (H.M.K.), Yale New Haven Hospital, New Haven, Conn; and the Emory University School of Medicine (V.V.), Atlanta, Ga.
Correspondence to Paul S. Chan, MD, MSc, Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111. E-mail pchan{at}cc-pc.com
Received March 26, 2009; accepted April 8, 2009.
Background— Among patients with acute myocardial infarction (AMI), depression is both common and underrecognized. The association of different manifestations of depression, somatic and cognitive, with depression recognition and long-term prognosis is poorly understood.
Methods and Results— Depression was confirmed in 481 AMI patients enrolled from 21 sites during their index hospitalization with a Patient Health Questionnaire (PHQ-9) score 
10. Within the PHQ-9, separate somatic and cognitive symptom scores were derived, and the independent association between these domains and the clinical recognition of depression, as documented in the medical records, was evaluated. In a separate multisite AMI registry of 2347 patients, the association between somatic and cognitive depressive symptoms and 4-year all-cause mortality and 1-year all-cause rehospitalization was evaluated. Depression was clinically recognized in 29% (n=140) of patients. Cognitive depressive symptoms (relative risk per SD increase, 1.14; 95% CI, 1.03 to 1.26; P=0.01) were independently associated with depression recognition, whereas the association for somatic symptoms and recognition (relative risk, 1.04; 95% CI, 0.87 to 1.26; P=0.66) was not significant. However, unadjusted Cox regression analyses found that only somatic depressive symptoms were associated with 4-year mortality (hazard ratio [HR] per SD increase, 1.22; 95% CI, 1.08 to 1.39) or 1-year rehospitalization (HR, 1.22; 95% CI, 1.11 to 1.33), whereas cognitive manifestations were not (HR for mortality, 1.01; 95% CI, 0.89 to 1.14; HR for rehospitalization, 1.01; 95% CI, 0.93 to 1.11). After multivariable adjustment, the association between somatic symptoms and rehospitalization persisted (HR, 1.16; 95% CI, 1.06 to 1.27; P=0.01) but was attenuated for mortality (HR, 1.07; 95% CI, 0.94 to 1.21; P=0.30).
Conclusions— Depression after AMI was recognized in fewer than 1 in 3 patients. Although cognitive symptoms were associated with recognition of depression, somatic symptoms were associated with long-term outcomes. Comprehensive screening and treatment of both somatic and cognitive symptoms may be necessary to optimize depression recognition and treatment in AMI patients.
Key Words: depression • myocardial infarction • therapy • mortality • rehospitalization
Paul A. Heidenreich, MD, was Guest Editor for this article.
The online-only Data Supplement is available at http://circoutcomes.ahajournals.org/cgi/content/full/10.1161/CIRCOUTCOMES.109.868588/DC1.