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From the Women's Health Program, Toronto General Research Institute, Behavioural Sciences and Health Division, and Kinesiology and Health Sciences, York University, Toronto, Ontario (S.L.G.); University Health Network Department of Psychiatry and University of Toronto (S.E.A.); University Health Network (R.P.); Credit Valley Hospital and University of Toronto (Z.M.S.); York University and University Health Network (J.I.); and University Health Network and University of Toronto (D.E.S.), Toronto, Ontario, Canada.
Address correspondence and reprint requests to Dr. Sherry L. Grace, Kinesiology and Health Sciences, York University, 368 Bethune, 4700 Keele Street, Toronto, ON M3J 1P3, Canada. E-mail: sgrace{at}yorku.ca
Objective: Recent research has linked depression to cardiac mortality, and shown a high burden of persistent depressive symptomatology among cardiac patients. The objective of this study was to longitudinally examine the prevalence and course of depressive symptomatology among women and men for 1 year after a cardiac event, and the effect of cardiac rehabilitation (CR) on this trajectory.
Methods: Nine hundred thirteen unstable angina (UA) and myocardial infarction patients from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months. Measures included CR participation, medication usage, and the Beck Depression Inventory (BDI). The longitudinal analysis was conducted using SAS PROC MIXED.
Results: At baseline there were 277 (31.3%) participants with elevated depressive symptomatology (BDI 
10), 131 (25.2%) at 6 months, and 107 (21.7%) at 1 year. Overall, approximately 5% were taking an antidepressant medication, and 20% attended CR over their year of recovery. Participants with greater depressive symptomatology participated in significantly fewer CR exercise sessions (r = –0.19, p = .02), and minimal psychosocial interventions were offered. The longitudinal analysis revealed that all participants experienced reduced depressive symptomatology over their year of recovery (p = .04), and younger, UA participants with lower family income fared worst (ps < 0.001). CR did not have an effect on depressive symptomatology over time, but women who attended CR were significantly more depressed than men (p = .01).
Conclusion: Depressed cardiac patients are undertreated and their symptomatology persists for up to 6 months. CR programs require greater resources to ensure that depressed participants adhere to exercise regimens, and are screened and treated for their elevated symptomatology.
Key Words: cardiac event • depressive symptoms • longitudinal study • gender • cardiac rehabilitation
Abbreviations: CR = cardiac rehabilitation; UA = unstable angina; MI = myocardial infarction; ACS = acute coronary syndromes; CCU = coronary care unit; CAD = Canadian dollars; USD = U.S. dollars; BDI = Beck Depression Inventory.
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S. L. Grace, Y. W. Leung, and D. E. Stewart A Prospective Examination of Antidepressant Use and Its Correlates in Patients With Acute Coronary Syndrome Psychosomatics, May 1, 2008; 49(3): 199 - 207. [Abstract] [Full Text] [PDF]
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 B. D. Thombs, S. L. Grace, and R. C. Ziegelstein Do Symptom Dimensions of Depression Following Myocardial Infarction Relate Differently to Physical Health Indicators and Cardiac Prognosis? Am J Psychiatry, July 1, 2006; 163(7): 1295 - 1296. [Full Text] [PDF]
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