| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
REVIEW ARTICLES |
From the Department of Rehabilitation Psychology, Institute of Psychology, University of Freiburg, Germany (J.B., M.S.); and the Department of Psychosomatic Medicine, University of Goettingen, Germany (C.H.-L.).
Address correspondence and reprint requests to Jürgen Barth, PhD, University of Freiburg, Institute of Psychology, Department of Rehabilitation Psychology, Freiburg, Germany. E-mail: mail{at}juergen-barth.de
BACKGROUND: Prospective studies on physically healthy subjects have shown an association between depression and the subsequent development of coronary heart disease (CHD). The relative risk in meta-analytic aggregation is 1.64 (confidence interval [CI], 1.29–2.08) for any CHD event. However, the adverse impact of depression on CHD patients has not yet been the subject of a meta-analysis.
OBJECTIVE: To quantify the impact of depressive symptoms (eg, BDI, HADS) or depressive disorders (major depression) on cardiac or all-cause mortality. We analyzed the strength of the relationship, the time dependency, and the differences in studies using depressive symptoms or a clinical diagnosis as predictors of mortality.
METHOD: English and German language databases (Medline, PsycInfo, PSYNDEX) from 1980 to 2003 were searched for prospective cohort studies. Sixty-two publications were identified. The inclusion criteria were met by 29 publications reporting on 20 studies. A random model was used to estimate the combined overall effect as crude odds ratios (OR) or adjusted hazard ratios (HR [adj]).
RESULTS: Depressive symptoms increase the risk of mortality in CHD patients. The risk of depressed patients dying in the 2 years after the initial assessment is two times higher than that of nondepressed patients (OR, 2.24; 1.37–3.60). This negative prognostic effect also remains in the long-term (OR, 1.78; 1.12–2.83) and after adjustment for other risk factors (HR [adj], 1.76; 1.27–2.43). The unfavorable impact of depressive disorders was reported for the most part in the form of crude odds ratios. Within the first 6 months, depressive disorders were found to have no significant effect on mortality (OR, 2.07; CI, 0.82–5.26). However, after 2 years, the risk is more than two times higher for CHD patients with clinical depression (OR, 2.61; 1.53–4.47). Only three studies reported adjusted hazard ratios for clinical depression and supported the results of the bivariate models.
CONCLUSIONS: Depressive symptoms and clinical depression have an unfavorable impact on mortality in CHD patients. The results are limited by heterogeneity of the results in the primary studies. There is no clear evidence whether self-report or clinical interview is the more precise predictor. Nevertheless, depression has to be considered a relevant risk factor in patients with CHD.
Key Words: depression, • coronary heart disease, • mortality, • meta-analysis, • depressive symptoms, • risk factor.
Abbreviations: AMI = acute myocardial infarction;; AP = angina pectoris;; BDI = Beck Depression Inventory;; CABG = coronary artery bypass graft;; CHD = coronary heart disease;; CI = confidence interval;; DIS = Diagnostic Interview Schedule;; DS = Zerssen Self-Rating Scale;; DSM = Diagnostic and Statistical Manual of Mental Disorders;; ECG = electrocardiogram;; f/u = follow-up period;; GMS = Global Mood Scale;; HADS = Hospital Anxiety and Depression Scale;; HDL = high-density lipoprotein;; HPA = hypothalamic–pituitary–adrenocortical axis;; HR (adj) = adjusted hazard ratio;; IL = interleukin;; LVEF = left ventricular ejection fraction;; Medline = database of the U.S. National Library of Medicine;; MI = myocardial infarction;; MD = major depression;; OR = odds ratio;; PSE = Present State Examination;; PsycInfo = database of the American Psychological Association;; PSYNDEX = database of the Center for Psychological Information and Documentation at the University of Trier, Germany;; PTCA = percutaneous transluminal coronary angioplasty;; RR = relative risk;; SBP = systolic blood pressure;; SCID = Structured Clinical Interview for DSM;; SDS = Zung Self-Rating Depression Scale;; TNF = tumor necrosis factor.
This article has been cited by other articles:
 |
|
 |
|
  A. Verdelho and J. M Ferro Late onset depressive symptoms can be a marker of cerebral vascular pathology J. Neurol. Neurosurg. Psychiatry, September 1, 2008; 79(9): 977 - 977. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Vaccarino, R. Lampert, J. D. Bremner, F. Lee, S. Su, C. Maisano, N. V. Murrah, L. Jones, F. Jawed, N. Afzal, et al. Depressive Symptoms and Heart Rate Variability: Evidence for a Shared Genetic Substrate in a Study of Twins Psychosom Med, July 1, 2008; 70(6): 628 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Terracciano, C. E. Lockenhoff, A. B. Zonderman, L. Ferrucci, and P. T. Costa Jr Personality Predictors of Longevity: Activity, Emotional Stability, and Conscientiousness Psychosom Med, July 1, 2008; 70(6): 621 - 627. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Huffman, L. T. Park, C. A. Welch, A. A. Nierenberg, J. L. Januzzi Jr., and S. R. Pomerantz Case 14-2008 -- A 78-Year-Old Man with Anergia and Anhedonia Associated with Cardiovascular Surgery N. Engl. J. Med., May 8, 2008; 358(19): 2051 - 2059. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Wouts, R. C. O. Voshaar, M. A. Bremmer, J. K. Buitelaar, B. W. J. H. Penninx, and A. T. F. Beekman Cardiac Disease, Depressive Symptoms, and Incident Stroke in an Elderly Population Arch Gen Psychiatry, May 1, 2008; 65(5): 596 - 602. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Dickens, L. McGowan, C. Percival, B. Tomenson, L. Cotter, A. Heagerty, and F. Creed New Onset Depression Following Myocardial Infarction Predicts Cardiac Mortality Psychosom Med, May 1, 2008; 70(4): 450 - 455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Lett, S. Ali, and M. Whooley Depression and Cardiac Function in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study Psychosom Med, May 1, 2008; 70(4): 444 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Rutledge, S. E. Linke, M. B. Olson, J. Francis, B. D. Johnson, V. Bittner, K. York, C. McClure, S. F. Kelsey, S. E. Reis, et al. Social Networks and Incident Stroke Among Women With Suspected Myocardial Ischemia Psychosom Med, April 1, 2008; 70(3): 282 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-K. Wong, E.W. Tang, P. Herbison, B. Birmingham, L. Barclay, and S.Y.F. Fu Pre-existent depression in the 2 weeks before an acute coronary syndrome can be associated with delayed presentation of the heart attack QJM, February 1, 2008; 101(2): 137 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Vaccarino, C. McClure, B. D. Johnson, D. S. Sheps, V. Bittner, T. Rutledge, L. J. Shaw, G. Sopko, M. B. Olson, D. S. Krantz, et al. Depression, the Metabolic Syndrome and Cardiovascular Risk Psychosom Med, January 1, 2008; 70(1): 40 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Zisook, L. Montross, J. Kasckow, S. Mohamed, B. W. Palmer, T. L. Patterson, S. Golshan, I. Fellows, D. Lehman, and E. Solorzano Subsyndromal Depressive Symptoms in Middle-Aged and Older Persons with Schizophrenia Am J Geriatr Psychiatry, December 1, 2007; 15(12): 1005 - 1014. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Vaccarino, B. D. Johnson, D. S. Sheps, S. E. Reis, S. F. Kelsey, V. Bittner, T. Rutledge, L. J. Shaw, G. Sopko, and C. N. Bairey Merz Depression, Inflammation, and Incident Cardiovascular Disease in Women With Suspected Coronary Ischemia: The National Heart, Lung, and Blood Institute Sponsored WISE Study J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2044 - 2050. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A Blumenthal, A. Sherwood, S. D. Rogers, M. A. Babyak, P. Murali Doraiswamy, L. Watkins, B. M. Hoffman, C. O'Connell, J. J. Johnson, S. M. Patidar, et al. Understanding prognostic benefits of exercise and antidepressant therapy for persons with depression and heart disease: the UPBEAT study rationale, design, and methodological issues Clinical Trials, October 1, 2007; 4(5): 548 - 559. [Abstract] [PDF]
|
|
|
|
|
|
P. de Jonge, D. Mangano, and M. A. Whooley Differential Association of Cognitive and Somatic Depressive Symptoms With Heart Rate Variability in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study Psychosom Med, October 1, 2007; 69(8): 735 - 739. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Carney and K. E. Freedland Depression and Coronary Heart Disease: More Pieces of the Puzzle Am J Psychiatry, September 1, 2007; 164(9): 1307 - 1309. [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Riekert, S. J. Bartlett, M. P. Boyle, J. A. Krishnan, and C. S. Rand The Association Between Depression, Lung Function, and Health-Related Quality of Life Among Adults With Cystic Fibrosis Chest, July 1, 2007; 132(1): 231 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Roy, A. Roy, and M. Affouf Depression is a Risk Factor for Poor Glycemic Control and Retinopathy in African-Americans With Type 1 Diabetes Psychosom Med, July 1, 2007; 69(6): 537 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. K. Myint, R. N. Luben, P. G. Surtees, N. W. J. Wainwright, A. A. Welch, S. A. Bingham, N. J. Wareham, R. D. Smith, I. M. Harvey, and K.-T. Khaw Self-Reported Mental Health-Related Quality of Life and Mortality in Men and Women in the European Prospective Investigation into Cancer (EPIC-Norfolk): A Prospective Population Study Psychosom Med, June 1, 2007; 69(5): 410 - 414. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. CARNEY and K. E. FREEDLAND Does treating depression improve survival after acute coronary syndrome?: Invited commentary on... Effects of antidepressant treatment following myocardial infarction The British Journal of Psychiatry, June 1, 2007; 190(6): 467 - 468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Dickens, L. McGowan, C. Percival, B. Tomenson, L. Cotter, A. Heagerty, and F. Creed Depression Is a Risk Factor for Mortality After Myocardial Infarction: Fact or Artifact? J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1834 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Rutledge and S. E Linke Phobic anxiety and depression increase the risk of ventricular arrhythmias in people with coronary artery disease Evid. Based Ment. Health, May 1, 2007; 10(2): 43 - 43. [Full Text] [PDF]
|
|
|
|
|
|
A. Mykletun, O. Bjerkeset, M. Dewey, M. Prince, S. Overland, and R. Stewart Anxiety, Depression, and Cause-Specific Mortality: The HUNT Study Psychosom Med, May 1, 2007; 69(4): 323 - 331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Carney, W. B. Howells, J. A. Blumenthal, K. E. Freedland, P. K. Stein, L. F. Berkman, L. L. Watkins, S. M. Czajkowski, B. Steinmeyer, J. Hayano, et al. Heart Rate Turbulence, Depression, and Survival After Acute Myocardial Infarction Psychosom Med, January 1, 2007; 69(1): 4 - 9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Rieckmann, W. Gerin, I. M. Kronish, M. M. Burg, W. F. Chaplin, G. Kong, F. Lesperance, and K. W. Davidson Course of Depressive Symptoms and Medication Adherence After Acute Coronary Syndromes: An Electronic Medication Monitoring Study J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2218 - 2222. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Nicholson, H. Kuper, and H. Hemingway 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 Eur. Heart J., December 1, 2006; 27(23): 2763 - 2774. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Rutledge, V. A. Reis, S. E. Linke, B. H. Greenberg, and P. J. Mills Depression in Heart Failure: A Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1527 - 1537. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. DICKENS, L. McGOWAN, C. PERCIVAL, B. TOMENSON, L. COTTER, A. HEAGERTY, and F. H. CREED Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction The British Journal of Psychiatry, October 1, 2006; 189(4): 367 - 372. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Rutledge, S. E. Reis, M. B. Olson, J. Owens, S. F. Kelsey, C. J. Pepine, S. Mankad, W. J. Rogers, C. N. B. Merz, G. Sopko, et al. Depression Symptom Severity and Reported Treatment History in the Prediction of Cardiac Risk in Women With Suspected Myocardial Ischemia: The NHLBI-Sponsored WISE Study. Arch Gen Psychiatry, August 1, 2006; 63(8): 874 - 880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Whooley Depression and cardiovascular disease: healing the broken-hearted. JAMA, June 28, 2006; 295(24): 2874 - 2881. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Whooley Mind your heart. Ann Intern Med, June 6, 2006; 144(11): 858 - 860. [Full Text] [PDF]
|
|
|
|
 |
|
 L D. Ried, M. J Tueth, M. D Taylor, B. C Sauer, L. M Lopez, and C. J Pepine Depressive Symptoms in Coronary Artery Disease Patients After Hypertension Treatment Ann. Pharmacother., April 1, 2006; 40(4): 597 - 604. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. C. de Geus Genetic pleiotropy in depression and coronary artery disease. Psychosom Med, March 1, 2006; 68(2): 185 - 186. [Full Text] [PDF]
|
|
|
|
|
|
J. M. McCaffery, N. Frasure-Smith, M.-P. Dube, P. Theroux, G. A. Rouleau, Q. Duan, and F. Lesperance Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med, March 1, 2006; 68(2): 187 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Rutledge, S. E. Reis, M. Olson, J. Owens, S. F. Kelsey, C. J. Pepine, S. Mankad, W. J. Rogers, G. Sopko, C. E. Cornell, et al. Depression is associated with cardiac symptoms, mortality risk, and hospitalization among women with suspected coronary disease: the NHLBI-sponsored WISE study. Psychosom Med, March 1, 2006; 68(2): 217 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Denollet, S. S. Pedersen, A. T.L. Ong, R. A.M. Erdman, P. W. Serruys, and R. T. van Domburg Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era Eur. Heart J., January 2, 2006; 27(2): 171 - 177. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Spindler and S. S. Pedersen Posttraumatic Stress Disorder in the Wake of Heart Disease: Prevalence, Risk Factors, and Future Research Directions Psychosom Med, September 1, 2005; 67(5): 715 - 723. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Maggi Review: depression may increase mortality in coronary heart disease Evid. Based Ment. Health, August 1, 2005; 8(3): 66 - 66. [Full Text] [PDF]
|
|
|
|
|
|
S. C. Matthews, R. A. Nelesen, and J. E. Dimsdale Depressive Symptoms Are Associated With Increased Systemic Vascular Resistance to Stress Psychosom Med, July 1, 2005; 67(4): 509 - 513. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Carney, K. E. Freedland, and D. S. Sheps Depression is a Risk Factor for Mortality in Coronary Heart Disease Psychosom Med, November 1, 2004; 66(6): 799 - 801. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
