Depressive symptoms in persons with acute coronary syndrome: Specific symptom scales and prognosis
Received 20 March 2009; received in revised form 29 June 2009; accepted 14 July 2009. published online 20 November 2009.
Abstract
Objective
To determine which particular depressive symptom scales, derived from three scales, predicted poorer prognosis in persons with acute coronary syndrome (ACS).
Methods
Hospitalized ACS patients (n=408) completed questionnaires (depression, vital exhaustion). Mokken scaling derived unidimensional scales. Major cardiac events (cardiac mortality, ACS, unplanned revascularization) were assessed at median 67 weeks post event.
Results
Only depressive symptoms of fatigue-sadness predicted prognosis in univariate (hazard ratio [HR]=1.8, 95% CI 1.1–3.0, P=.025) and multivariate analysis (HR=1.8, 95% CI 1.1–2.9, P=.025). Symptoms of anhedonia (HR=1.6, 95% CI 0.9–2.8, P=.102) and depressive cognitions (HR=1.3, 95% CI 0.7–2.2, P=.402) did not.
Conclusion
Symptoms of fatigue-sadness, but not other symptoms, were associated with increased risk of major cardiac events. Depression should be considered as a multidimensional, rather than a unidimensional, entity when designing interventions.
aDepartment of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
bDepartment of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
Corresponding author. Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland. Tel.: + 353 (0) 1 4022718; fax: + 353 (0) 1 4022764.
ABSTRACT