Abstract
PURPOSE: Research demonstrates that depression at the time of a cardiac event predicts early mortality. However, the best time for depression screening is unknown. We investigated the prognostic importance of inhospital and 2-month depressive symptoms in predicting 12-year mortality in female cardiac patients.
METHODS: A consecutive series of 170 women admitted to hospital after acute myocardial infarction or for coronary artery bypass graft surgery completed the Hospital Anxiety and Depression Scale inhospital and 2 months later. Hospital Anxiety and Depression Scale's depression subscale scores of 4 to 7 were classified as "mild" depressive symptoms and 8+ as "moderate/severe" depressive symptoms. Mortality was tracked through the Australian National Death Index and other sources.
RESULTS: One hundred sixty-three (96%) of the 170 women were successfully tracked after 12 years. Of these women, 136 (83%) completed the depression subscale of the Hospital Anxiety and Depression Scale at both assessments and were included in the analyses. Over 12 years, 45 (33%) women died. Using logistic regression and controlling for age, disease severity, and diabetes, mild inhospital depression predicted mortality (P = .02), whereas moderate/severe inhospital depression did not (P = .14). At 2 months, moderate/severe depression predicted mortality (P = .05), whereas mild depression did not (P = .09). Half the patients (49%) changed depression class by the 2-month assessment. The death rate was highest (64%) in those whose mild inhospital depressive symptoms increased to moderate/severe and lowest (14%) in those whose moderate/severe inhospital symptoms remitted.
CONCLUSIONS: Mild inhospital depression and moderate/severe 2-month depression were predictive of 12-year deaths. The findings suggest a prognostic benefit in undertaking repeat depression screening 2 months after an acute cardiac event.