Do Subgroups Of Depressed MI Patients Defined On Timing And Recurrence Of Depression Differ In Their

1
Do Subgroups Of Depressed MI Patients Defined On
Timing And Recurrence Of Depression Differ In
Their Profile Of Depressive Symptoms?
Marij Zuidersma, Peter de Jonge
Interdisciplinary Center for Psychiatric
Epidemiology, University Medical Center
Groningen, University of Groningen, The
Netherlands, m.zuidersma_at_med.umcg.nl
ICPE
Results
Introduction
Depression after an acute coronary event is
associated with an increased risk of new
cardiovascular events. Several studies showed
that depressed acute coronary syndrome (ACS)
patients who have a first-ever depressive episode
with an onset after the event are at increased
risk1-4. Another study showed that the presence
of somatic symptoms of depression rather than
cognitive symptoms is associated with an
increased risk in depressed myocardial infarction
(MI) patients5. We explored whether symptom
profiles would differ between subgroups of
depressed MI patients defined on the onset and
recurrence of the depressive episode.
A total of 440 MI patients with a depressive
episode were included. Figure 1 shows the
prevalence of each of the ten symptoms of
depression in the different subgroups. The
prevalence of specific symptoms was the same in
each of the subgroups, except for one. Thoughts
about death or suicide were significantly less
prevalent in MI patients with a first-ever
depressive episode compared to those with a
recurrent depressive episode (OR0.54 95 CI
0.34-0.87 p0.012).
Cognitive symptoms
Somatic symptoms
Methods
Procedure Depressed MI patients who were enrolled
in DepreMI and MIND-IT were included. DepreMI was
an observational cohort study assessing the
prognostic impact of depression on cardiovascular
prognosis in MI patients, and MIND-IT was an
intervention trial assessing effects of
antidepressant treatment in depressed MI
patients. The presence of a depressive episode
was assessed with the Composite International
Diagnostic Interview (CIDI) at 3, 6, 9 or 12
months after the MI. The CIDI was extended to
gather more information about timing of the
depressive episode relative to the
MI. Analysis The presence or absence of each of
the ten ICD-10 symptoms of depression was
established with the CIDI. Patients with post-MI
depression were classified into subgroups
depending on whether the depressive episode was
first-ever or recurrent and whether its onset was
before or after the MI. The prevalence of each of
the specific symptoms of depression was compared
for the following subgroups of depressed MI
patients ? First depressive episode versus
recurrent depressive episode ? Onset depressive
episode before versus after MI ? First episode
with onset after MI versus recurrent episode
and/or onset episode before MI

Conclusion
Symptom profiles did not differ among subgroups
of depressed MI patients defined on the onset and
recurrence of the depressive episode. Only
thoughts about death or suicide was more
prevalent in MI patients with a recurrent
episode, compared to those with a first episode,
which may have been a coincidental finding. These
results suggest that somatic symptoms and first
depressive episodes with an onset after the MI
are two independent risk factors for worse
cardiovascular outcomes.
References
1. Grace SL et al. Am J Cardiol
1-11-2005961179-1185.
4. Parker GB et al. Biol Psychiatry
15-10-200864660-666. 2. Dickens C et al.
Psychosom Med 200870450-455.
5. de Jonge P et al. Am J Psychiatry
2006 Jan163(1)138-44. 3. de Jonge P et al. J
Am Coll Cardiol 5-12-2006482204-2208.
Figure 1 Prevalence of each of the 10 ICD-10
symptoms of depression in subgroups of depressed
MI patients according to recurrence and onset of
the depressive episode. p0.012 (OR0.54
(0.34-0.87))