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From the Research Center, Montreal Heart Institute, Montreal, Canada (N.F.-S., F.L., M.J., M.T., M.G.B.); Department of Psychiatry, McGill University, Montreal, Canada (N. F.-S., F.L.); School of Nursing and Department of Epidemiology and Biostatistics, McGill University, Montreal Canada (N.F.-S.); Departments of Psychiatry (N.F.-S., F.L.) and Medicine (M.J., M.T., M.G.B.), University of Montreal, Montreal, Canada
Address reprint requests to: Nancy Frasure-Smith, Research Center, Montreal Heart Institute, 5000 Belanger St. E, Montreal, Quebec, Canada, H1T 1C8. E:mail: frsm{at}icm.umontreal.ca
OBJECTIVE: The purpose of this study was to assess gender differences in the impact of depression on 1-year cardiac mortality in patients hospitalized for an acute myocardial infarction (MI).
METHODS: Secondary analysis was performed on data from two studies that used the Beck Depression Inventory (BDI) to assess depression symptoms during hospitalization: a prospective study of post-MI risk and a randomized trial of psychosocial intervention (control group only). The sample included 896 patients (283 women) who survived to discharge and received usual posthospital care. Multivariate logistic regression analysis was used to assess the risk of 1-year cardiac mortality associated with baseline BDI scores.
RESULTS: There were 290 patients (133 women) with BDI scores 
10 (at least mild to moderate symptoms of depression); 8.3% of the depressed women died of cardiac causes in contrast to 2.7% of the nondepressed. For depressed men, the rate of cardiac death was 7.0% in contrast to 2.4% of the nondepressed. Increased BDI scores were significantly related to cardiac mortality for both genders [the odds ratio for women was 3.29 (95% confidence interval (CI) = 1.02–10.59); for men, the odds ratio was 3.05 (95% CI = 1.29–7.17)]. Control for other multivariate predictors of mortality in the data set (age, Killip class, the interactions of gender by non-Q wave MI, gender by left ventricular ejection fraction, and gender by smoking) did not change the impact of the BDI for either gender.
CONCLUSIONS: Depression in hospital after MI is a significant predictor of 1-year cardiac mortality for women as well as for men, and its impact is largely independent of other post-MI risks.
Key Words: depression, • myocardial infarction, • women, • prognosis.
Abbreviations: BDI = Beck Depression Inventory;; PSSS = Perceived Social Support Scale;; CI = confidence interval;; EPPI = Emotions and Prognosis Post-Infarct;; MCS = Marlowe-Crowne Social Desirability Scale;; M-HART = Montreal Heart Attack Readjustment Trial;; MI = myocardial infarction;; STAI = State-Trait Anxiety Inventory.
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