This Article  • References  • Full text PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Impact on 6-Month Survival

Nancy Frasure-Smith, PhD; François Lespérance, MD; Mario Talajic, MD

JAMA. 1993;270(15):1819-1825.

Abstract
Objective.
—To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction (Ml) would have an independent impact on cardiac mortality over the first 6 months after discharge.

Design.
—Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set.

Setting.
—A large, university-affiliated hospital specializing in cardiac care, located in Montreal, Quebec.

Patients.
—All consenting patients (N=222) who met established criteria for Ml between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits (range, 24 to 88 years; mean, 60 years). The sample was 78% male.

Primary Outcome Measure.
—Survival status at 6 months.

Results.
—By 6 months, 12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87; P=.0006). The impact of depression remained after control for left ventricular dysfunction (Killip class) and previous Ml, the multivariate significant predictors of mortality in the data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14 to 5.44; P=.013).

Conclusion.
—Major depression in patients hospitalized following an Ml is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous Ml. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms.

(JAMA. 1993;270:1819-1825)

Author Affiliations
From the Research Center, Montreal (Quebec) Heart Institute (Drs Frasure-Smith, Lespérance, and Talajic); Department of Psychiatry, McGill University, Montreal, Quebec (Dr Frasure-Smith); and Departments of Psychiatry (Dr Lespérance) and Medicine (Dr Talajic), University of Montreal (Quebec).

Footnotes
Reprint requests to Research Center, Montreal Heart Institute, 5000 Bélanger E, Montreal, Quebec, Canada H1T 1C8 (Dr Frasure-Smith).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Psychotropic medication: curing illness or creating problems?
Jolly and Langman
Heart 2009;95:1893-1894.
FULL TEXT  

Prognosis in Heart Failure and the Value of {beta}-Blockers Are Altered by the Use of Antidepressants and Depend on the Type of Antidepressants Used
Fosbol et al.
Circ Heart Fail 2009;2:582-590.
ABSTRACT | FULL TEXT  

Inflammatory Protein Levels and Depression Screening After Coronary Stenting Predict Major Adverse Coronary Events
Frazier et al.
Biol Res Nurs 2009;11:163-173.
ABSTRACT  

Depression and Increased Mortality in Diabetes: Unexpected Causes of Death
Lin et al.
Ann Fam Med 2009;7:414-421.
ABSTRACT | FULL TEXT  

Psychiatric Characteristics Associated With Long-term Mortality Among 361 Patients Having an Acute Coronary Syndrome and Major Depression: Seven-Year Follow-up of SADHART Participants
Glassman et al.
Arch Gen Psychiatry 2009;66:1022-1029.
ABSTRACT | FULL TEXT  

Joint Modeling of Longitudinal Changes in Depressive Symptoms and Mortality in a Sample of Community-Dwelling Elderly People
Zhang et al.
Psychosom. Med. 2009;71:704-714.
ABSTRACT | FULL TEXT  

Cognitive-behavioural therapy as an adjunctive treatment in chronic physical illness
Halford and Brown
Adv. Psychiatr. Treat. 2009;15:306-317.
ABSTRACT | FULL TEXT  

Depression After Coronary Artery Disease Is Associated With Heart Failure
May et al.
J Am Coll Cardiol 2009;53:1440-1447.
ABSTRACT | FULL TEXT  

Prevention of first-episode depression: progress and potential
Robinson and Jorge
Br. J. Psychiatry 2009;194:296-297.
ABSTRACT | FULL TEXT  

Health care use in depressed, elderly, cardiac patients and the effect of antidepressant use
Blanchette et al.
Am J Health Syst Pharm 2009;66:366-372.
ABSTRACT | FULL TEXT  

Depression and heart disease: What do we know, and where are we headed?
POZUELO et al.
Cleveland Clinic Journal of Medicine 2009;76:59-70.
ABSTRACT | FULL TEXT  

Depression in Late Life: Review and Commentary
Blazer
Focus 2009;7:118-136.
ABSTRACT | FULL TEXT  

Impact of Depression on Sex Differences in Outcome After Myocardial Infarction
Parashar et al.
Circ Cardiovasc Qual Outcomes 2009;2:33-40.
ABSTRACT | FULL TEXT  

Cognitive-Personality Style as Vulnerability to Depression in Patients With Coronary Artery Disease: Roles of Sociotropy and Autonomy
Stafford et al.
Psychosom. Med. 2009;71:63-69.
ABSTRACT | FULL TEXT  

Antidepressant Use, Depression, and Survival in Patients With Heart Failure
O'Connor et al.
Arch Intern Med 2008;168:2232-2237.
ABSTRACT | FULL TEXT  

Sex and Gender Discrepancies in Health-Related Quality of Life Outcomes Among Patients With Established Coronary Artery Disease
Norris et al.
Circ Cardiovasc Qual Outcomes 2008;1:123-130.
ABSTRACT | FULL TEXT  

The influence of seasonal variation on cardiac surgery: a time-related clinical outcome predictor.
Shuhaiber et al.
J. Thorac. Cardiovasc. Surg. 2008;136:894-899.
ABSTRACT | FULL TEXT  

Invited Commentary: Stress and Mortality
Hotopf et al.
Am J Epidemiol 2008;168:492-495.
ABSTRACT | FULL TEXT  

Pre-Existing Major Depression Predicts In-Hospital Cardiac Complications After Acute Myocardial Infarction
Huffman et al.
Psychosomatics 2008;49:309-316.
ABSTRACT | FULL TEXT  

Inflammation and its relevance to psychiatry
Cavanagh and Mathias
Adv. Psychiatr. Treat. 2008;14:248-255.
ABSTRACT | FULL TEXT  

Heterogeneity in Randomized Controlled Trials of Long Chain (Fish) Omega-3 Fatty Acids in Restenosis, Secondary Prevention and Ventricular Arrhythmias
Jenkins et al.
J. Am. Coll. Nutr. 2008;27:367-378.
ABSTRACT | FULL TEXT  

Depressive Symptoms Predict Heart Rate Recovery After Exercise Treadmill Testing in Patients With Coronary Artery Disease: Results From the Psychophysiological Investigations of Myocardial Ischemia Study
Hughes et al.
Psychosom. Med. 2008;70:456-460.
ABSTRACT | FULL TEXT  

Elevated Inflammation Levels in Depressed Adults With a History of Childhood Maltreatment
Danese et al.
Arch Gen Psychiatry 2008;65:409-415.
ABSTRACT | FULL TEXT  

Depressive Symptoms and Smoking Cessation After Hospitalization for Cardiovascular Disease
Thorndike et al.
Arch Intern Med 2008;168:186-191.
ABSTRACT | FULL TEXT  

Depression and Coronary Artery Disease: Is There a Platelet Link?
Ziegelstein et al.
Mayo Clin Proc. 2007;82:1366-1368.
FULL TEXT  

AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services: Endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons
Thomas et al.
J Am Coll Cardiol 2007;50:1400-1433.
FULL TEXT  

Understanding prognostic benefits of exercise and antidepressant therapy for persons with depression and heart disease: the UPBEAT study rationale, design, and methodological issues
Blumenthal et al.
Clin Trials 2007;4:548-559.
ABSTRACT  

Depression and Coronary Heart Disease: More Pieces of the Puzzle
Carney and Freedland
Am. J. Psychiatry 2007;164:1307-1309.
FULL TEXT  

Anxiety Predicts Mortality and Morbidity After Coronary Artery and Valve Surgery A 4-Year Follow-Up Study
Szekely et al.
Psychosom. Med. 2007;69:625-631.
ABSTRACT | FULL TEXT  

Treatment of Post-Myocardial Infarction Depressive Disorder: A Randomized, Placebo-Controlled Trial With Mirtazapine
Honig et al.
Psychosom. Med. 2007;69:606-613.
ABSTRACT | FULL TEXT  

Coronary Artery Disease and Depression: Patients With More Depressive Symptoms Have Lower Cardiovascular Reactivity During Laboratory-Induced Mental Stress
York et al.
Psychosom. Med. 2007;69:521-528.
ABSTRACT | FULL TEXT  

Effects of antidepressant treatment following myocardial infarction
van MELLE et al.
Br. J. Psychiatry 2007;190:460-466.
ABSTRACT | FULL TEXT  

A Cohort Study of People With Diabetes and Their First Foot Ulcer: The role of depression on mortality
Ismail et al.
Diabetes Care 2007;30:1473-1479.
ABSTRACT | FULL TEXT  

Translating Evidence Into Practice: Are We Neglecting the Neediest?
Spertus and Furman
Arch Intern Med 2007;167:987-988.
FULL TEXT  

Significant and increasing depressive symptoms are associated with increased risk of new cardiac events in people with a heart attack in the previous year
Huffman
Evid. Based Ment. Health 2007;10:42-42.
FULL TEXT  

The impact of angina and cardiac history on health-related quality of life and depression in coronary heart disease patients
Gravely-Witte et al.
Chronic Illness 2007;3:66-76.
ABSTRACT  

Self-Reported Depression and Cardiovascular Risk Factors in a Community Sample of Women
Jacka et al.
Psychosomatics 2007;48:54-59.
ABSTRACT | FULL TEXT  

Patient Satisfaction With Treatment After Acute Myocardial Infarction: Role of Psychosocial Factors
Barry et al.
Psychosom. Med. 2007;69:115-123.
ABSTRACT | FULL TEXT  

Antidepressants in Coronary Heart Disease: SSRIs Reduce Depression, But Do They Save Lives?
Glassman and Bigger
JAMA 2007;297:411-412.
FULL TEXT  

Impact of Anxiety and Perceived Control on In-Hospital Complications After Acute Myocardial Infarction
Moser et al.
Psychosom. Med. 2007;69:10-16.
ABSTRACT | FULL TEXT  

Cardioversion of Persistent Atrial Arrhythmia After Treatment With Venlafaxine in Successful Management of Major Depression and Posttraumatic Stress Disorder
Finch and van Zyl
Psychosomatics 2006;47:533-536.
ABSTRACT | FULL TEXT  

Raymond Prince: Reflections on his Career Contributions to Transcultural Psychiatry
Wintrob
Transcultural Psychiatry 2006;43:523-532.
 

Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies
Nicholson et al.
Eur Heart J 2006;27:2763-2774.
ABSTRACT | FULL TEXT  

Medical Implications of the Male Biological Clock.
Lewis et al.
JAMA 2006;296:2369-2371.
FULL TEXT  

Rapid screening for major depression in post-myocardial infarction patients: an investigation using Beck Depression Inventory II items
Huffman et al.
Heart 2006;92:1656-1660.
ABSTRACT | FULL TEXT  

Time course of depression and outcome of myocardial infarction.
Parashar et al.
Arch Intern Med 2006;166:2035-2043.
ABSTRACT | FULL TEXT  

Adverse psychological and coronary risk profiles in young patients with coronary artery disease and benefits of formal cardiac rehabilitation.
Lavie and Milani
Arch Intern Med 2006;166:1878-1883.
ABSTRACT | FULL TEXT  

Phobic anxiety, depression, and risk of ventricular arrhythmias in patients with coronary heart disease.
Watkins et al.
Psychosom. Med. 2006;68:651-656.
ABSTRACT | FULL TEXT  

Course of Depressive Symptoms After Myocardial Infarction and Cardiac Prognosis: A Latent Class Analysis
Kaptein et al.
Psychosom. Med. 2006;68:662-668.
ABSTRACT | FULL TEXT  

Minor Depression as a Cardiac Risk Factor After Coronary Artery Bypass Surgery
Rafanelli et al.
Psychosomatics 2006;47:289-295.
ABSTRACT | FULL TEXT  

Type 2 diabetes does not increase risk of depression.
Brown et al.
CMAJ 2006;175:42-46.
ABSTRACT | FULL TEXT  

Psychosocial factors and coronary calcium in adults without clinical cardiovascular disease.
Diez Roux et al.
ANN INTERN MED 2006;144:822-831.
ABSTRACT | FULL TEXT  

Symptoms of Posttraumatic Stress Disorder in Patients Who Have Had a Myocardial Infarction
Shemesh et al.
Psychosomatics 2006;47:231-239.
ABSTRACT | FULL TEXT  

Understanding Comorbidity With Depression and Anxiety Disorders
Aina and Susman
JAOA: Journal of the American Osteopathic Association 2006;106:S9-S14.
ABSTRACT | FULL TEXT  

Depressive Symptoms After Acute Myocardial Infarction: Evidence for Highest Rates in Younger Women.
Mallik et al.
Arch Intern Med 2006;166:876-883.
ABSTRACT | FULL TEXT  

Antiplatelet Activity During Coadministration of the Selective Serotonin Reuptake Inhibitor Paroxetine and Aspirin in Male Smokers: A Randomized, Placebo-Controlled, Double-blind Trial.
Kotzailias et al.
J Clin Pharmacol 2006;46:468-475.
ABSTRACT | FULL TEXT  

Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin.
McCaffery et al.
Psychosom. Med. 2006;68:187-200.
ABSTRACT | FULL TEXT  

"Major" Depressive Disorder, Coronary Heart Disease, and the DSM-IV Threshold Problem
Ketterer et al.
Psychosomatics 2006;47:50-55.
ABSTRACT | FULL TEXT  

Transforming Mental Health Care at the Interface With General Medicine: Report for the Presidents Commission
Unutzer et al.
Psychiatr. Serv. 2006;57:37-47.
ABSTRACT | FULL TEXT  

Premenstrual Symptoms and Perimenopausal Depression
Richards et al.
Am. J. Psychiatry 2006;163:133-137.
ABSTRACT | FULL TEXT  

Symptom Dimensions of Depression Following Myocardial Infarction and Their Relationship With Somatic Health Status and Cardiovascular Prognosis
de Jonge et al.
Am. J. Psychiatry 2006;163:138-144.
ABSTRACT | FULL TEXT  

Depression and Prehospital Delay in the Context of Myocardial Infarction
Bunde and Martin
Psychosom. Med. 2006;68:51-57.
ABSTRACT | FULL TEXT  

Depression after myocardial infarction is a risk factor for declining health related quality of life and increased disability and cardiac complaints at 12 months
de Jonge et al.
Heart 2006;92:32-39.
ABSTRACT | FULL TEXT  

The brain and the heart: the twain meet
Ziegelstein and Thombs
Eur Heart J 2005;26:2607-2608.
FULL TEXT  

Association Between Depressive Episode Before First Myocardial Infarction and Worse Cardiac Failure Following Infarction
Dickens et al.
Psychosomatics 2005;46:523-528.
ABSTRACT | FULL TEXT  

Depression and Medication Adherence in Outpatients With Coronary Heart Disease: Findings From the Heart and Soul Study
Gehi et al.
Arch Intern Med 2005;165:2508-2513.
ABSTRACT | FULL TEXT  

Depressive Symptoms and 24-Hour Urinary Norepinephrine Excretion Levels in Patients With Coronary Disease: Findings From the Heart and Soul Study
Otte et al.
Am. J. Psychiatry 2005;162:2139-2145.
ABSTRACT | FULL TEXT  

Trends in the Prescribing of Antidepressants Following Acute Myocardial Infarction, 1993-2002
Benazon et al.
Psychosom. Med. 2005;67:916-920.
ABSTRACT | FULL TEXT  

Health Locus of Control Predicts Survival after Lung Transplant
Burker et al.
J Health Psychol 2005;10:695-704.
ABSTRACT  

Clinical Depression and Regulation of the Inflammatory Response During Acute Stress
Miller et al.
Psychosom. Med. 2005;67:679-687.
ABSTRACT | FULL TEXT  

Depression Following Acute Myocardial Infarction: A Prospective Relationship With Ongoing Health and Function
Fauerbach et al.
Psychosomatics 2005;46:355-361.
ABSTRACT | FULL TEXT  

Association of anger proneness, depression and low social support with peripheral arterial disease: the Atherosclerosis Risk in Communities Study
Wattanakit et al.
Vasc Med 2005;10:199-206.
ABSTRACT  

Low Heart Rate Variability and the Effect of Depression on Post-Myocardial Infarction Mortality
Carney et al.
Arch Intern Med 2005;165:1486-1491.
ABSTRACT | FULL TEXT  

Depression, Healing, and Recovery From Coronary Artery Bypass Surgery
Doering et al.
Am J Crit Care 2005;14:316-324.
ABSTRACT | FULL TEXT  

Effects of Antidepressant Medication on Morbidity and Mortality in Depressed Patients After Myocardial Infarction
Taylor et al.
Arch Gen Psychiatry 2005;62:792-798.
ABSTRACT | FULL TEXT  

The Effect of a Telephone Counseling Intervention on Self-Rated Health of Cardiac Patients
Bambauer et al.
Psychosom. Med. 2005;67:539-545.
ABSTRACT | FULL TEXT  

Depressive Symptoms Predict Norepinephrine Response to a Psychological Stressor Task in Alzheimer's Caregivers
Mausbach et al.
Psychosom. Med. 2005;67:638-642.
ABSTRACT | FULL TEXT  

Screening for Depression: This Is the Heart of the Matter
Grissom and Phillips
Arch Intern Med 2005;165:1214-1215.
FULL TEXT  

Coronary and Aortic Calcification in Women With a History of Major Depression
Agatisa et al.
Arch Intern Med 2005;165:1229-1236.
ABSTRACT | FULL TEXT  

Depressive Symptoms and Heart Rate Variability in Postmenopausal Women
Kim et al.
Arch Intern Med 2005;165:1239-1244.
ABSTRACT | FULL TEXT  

Long-term Risk for Depressive Symptoms After a Medical Diagnosis
Polsky et al.
Arch Intern Med 2005;165:1260-1266.
ABSTRACT | FULL TEXT  

Depression and Heart Rate Variability in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study
Gehi et al.
Arch Gen Psychiatry 2005;62:661-666.
ABSTRACT | FULL TEXT  

Can Doctors and Nurses Recognize Depression in Patients Hospitalized With an Acute Myocardial Infarction in the Absence of Formal Screening?
Ziegelstein et al.
Psychosom. Med. 2005;67:393-397.
ABSTRACT | FULL TEXT  

Reflections on Depression as a Cardiac Risk Factor
Frasure-Smith and Lesperance
Psychosom. Med. 2005;67:S19-S25.
ABSTRACT | FULL TEXT  

Depression and Smoking in Coronary Heart Disease
Freedland et al.
Psychosom. Med. 2005;67:S42-S46.
ABSTRACT | FULL TEXT  

Lessons From SADHART, ENRICHD, and Other Trials
Joynt and O'Connor
Psychosom. Med. 2005;67:S63-S66.
ABSTRACT | FULL TEXT  

Psychiatry and Cardiovascular Disease
Schulman et al.
Focus 2005;3:208-224.
ABSTRACT | FULL TEXT  

Health care professionals in a heart failure team
Jaarsma
Eur J Heart Fail 2005;7:343-349.
ABSTRACT | FULL TEXT  

Prevalence of Hostility in Young Coronary Artery Disease Patients and Effects of Cardiac Rehabilitation and Exercise Training
Lavie and Milani
Mayo Clin Proc. 2005;80:335-342.
ABSTRACT  

Depression and Cardiovascular Disease: A Call For Recognition
Rumsfeld and Ho
Circulation 2005;111:250-253.
FULL TEXT  

Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery
Mallik et al.
Circulation 2005;111:271-277.
ABSTRACT | FULL TEXT  

Depression: An Update for the Clinician
Nierenberg et al.
Focus 2005;3:3-12.
FULL TEXT  

p38 MAP kinase inhibitor reverses stress-induced cardiac myocyte dysfunction
Kan et al.
J. Appl. Physiol. 2005;98:77-82.
ABSTRACT | FULL TEXT  

Longitudinal Course of Depressive Symptomatology After a Cardiac Event: Effects of Gender and Cardiac Rehabilitation
Grace et al.
Psychosom. Med. 2005;67:52-58.
ABSTRACT | FULL TEXT  

Psychologic Distress in Postmyocardial Infarction Patients Who Have Returned to Work
Brisson et al.
Psychosom. Med. 2005;67:59-63.
ABSTRACT | FULL TEXT  

Heart and mind: (1) relationship between cardiovascular and psychiatric conditions
Shah et al.
Postgrad. Med. J. 2004;80:683-689.
ABSTRACT | FULL TEXT  

Depression as a Risk Factor for Mortality in Patients With Coronary Heart Disease: A Meta-analysis
Barth et al.
Psychosom. Med. 2004;66:802-813.
ABSTRACT | FULL TEXT