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ORIGINAL ARTICLE |
From the Toronto General Hospital, University Health Network (J.I., B.B., S.J.); Departments of Psychiatry (J.I., B.B.) and Medicine (P.D.), University of Toronto, Toronto; Institute for Clinical Evaluative Sciences in Ontario (A.B.), Toronto; St. Michael’s Hospital (M.P., P.D.), Toronto, Ontario; Faculty of Medicine, University of British Columbia (J.C.), Vancouver, British Columbia; and Departments of Medicine (S.C.) and Clinical Epidemiology and Biostatistics (R.R., M.G.), McMaster University, Hamilton, Ontario, Canada.
Address reprint requests to: Jane Irvine, DPhil, CPsych, College Wing-2-330, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, Ontario, Canada, M5G 2C4. Email: jane.irvine{at}utoronto.ca
OBJECTIVES: This study examined the impact of depressive symptoms and social support on 2-year sudden cardiac death (SCD) risk, controlling for fatigue symptoms.
METHODS: Myocardial infarction (MI) patients (N = 671) participating in the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial completed measures of depression, hostility, and social support.
RESULTS: After controlling for significant biological predictors, psychosocial predictors of increased SCD risk in the survival analysis were greater social network contacts (RR = 1.04; 95% CI = 1.01–1.06; p < .007), lower social participation (RR = 0.98; 95% CI = 0.96–1.00; p < .05), and, in placebo-treated patients, elevated depressive symptoms (RR = 2.45; 95% CI = 1.14–5.35; p < .02). Fatigue was associated with SCD (RR = 1.31; 95% CI = 1.11–1.53; p < .001), and, when included in the model, diminished the influence of depression (RR = 1.73; 95% CI = 0.75–3.98; p = .20). When the cognitive-affective depressive symptoms were examined separately from somatic symptoms, there was a trend for an association between cognitive-affective symptoms and SCD in placebo-treated patients after controlling for fatigue (RR = 1.09; 95% CI = 0.99–1.19, p < .06).
CONCLUSIONS: Symptoms of depression and fatigue overlap in patients with MI. The trend for the cognitive-affective symptoms of depression to be associated with SCD risk, even after controlling for dyspnea/fatigue, suggests that the association between depression and mortality after AMI cannot be entirely explained as a confound of cardiac-related fatigue. The independent contribution of social participation suggests a role of both depressive symptomatology and social factors in influencing mortality risk after MI.
Key Words: depression • social support • cardiac mortality • acutemyocardial infarction
Abbreviations: AMI = acute myocardial infarction; BDI = Beck DepressionInventory; CAMIAT = Canadian Amiodarone Myocardial InfarctionArrhythmia Trial; CHF = congestive heart failure; MI =myocardial infarction; SCD = sudden cardiac death.
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