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From the Department of Psychiatry (R.A.M., D.G., A.D.), University of Oxford, Warneford Hospital, Oxford; Department of Health Studies (D.R.T.), University of York, Heslington, York; Division of Public Health and Primary Care (A.N., J.U.), Institute of Health Sciences, Oxford; and Department of Public Health and Health Policy (N.H.), Oxfordshire Health Authority, Oxford, United Kingdom.
Address reprint requests to: Professor R. A. Mayou, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom. Email: richard.mayou{at}psych.ox.ac.uk
OBJECTIVE: The objective of this study was to investigate the significance of emotional distress immediately after a myocardial infarction as a predictor of physical, psychological, and social outcomes and resource use.
METHODS: In an epidemiological survey, demographic and cardiological data were obtained for all patients from a defined geographical area who had had a myocardial infarction (according to diagnostic criteria of the Monitoring Trends and Determinants in Cardiovascular Disease [MONICA] trial). Hospital survivors were interviewed and were asked to complete self-report assessments on mental state and quality of life. Full replies were available at baseline for 347 subjects. Self-report follow-up questionnaire information was collected 3 months and 1 year later.
RESULTS: Fifteen percent of patients scored as probable cases of anxiety or depression. They were more likely than noncases to report preinfarct distress and poor adjustment (as indicated on the 36-item Medical Outcome Study short form). There was an improvement at 3 months, but there was little overall or individual change after that time. Anxiety and depression did not predict subsequent mortality but did significantly predict poor outcome at 1 year on all dimensions of the 36-item short form quality-of-life measure and on specific measures of everyday activity and reports of chest pain, use of primary care resources, and secondary prevention lifestyle changes.
CONCLUSIONS: Subjects who are distressed in the hospital are at high risk of adverse psychological and quality-of-life outcomes during the ensuing year. Our findings strengthen the argument for in-hospital identification and treatment of patients with depression and anxiety after myocardial infarction.
Key Words: myocardial infarction • outcome • depression • anxiety • predictors
Abbreviations: HAD = Hospital Anxiety and Depression Scale; MI =myocardial infarction; MONICA = Monitoring Trends and Determinants in Cardiovascular Disease Study; SF-36 = 36-item Medical Outcomes Study short form.
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