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Depression and Prehospital Delay in the Context of Myocardial Infarction

From the Department of Psychology (J.B., R.M.) and College of Nursing (R.M.), University of Iowa, Iowa City, IA.

Address correspondence and reprint requests to René Martin, PhD, Adult & Gerontological Nursing 374 NB, 50 Newton Road, College of Nursing, University of Iowa, Iowa City, IA 52242. E-mail: rene-martin{at}uiowa.edu.

Objective: The purpose of this study was to evaluate how depression might influence treatment-seeking behaviors in the context of evolving symptoms of myocardial infarction (MI).

Methods: Post-MI patients (n = 433) completed a retrospective self-report measure of depressive symptoms with regard to the 2 weeks preceding the MI and a semistructured interview regarding their treatment-seeking behaviors.

Results: Survival analyses found that delay in seeking treatment for acute MI symptoms was observed among participants who (1) attributed their symptoms to noncardiac causes, (2) perceived their symptoms to be relatively mild, (3) experienced gastrointestinal distress, (4) did not experience sweating, and (5) reported being depressed during the 2 weeks before hospitalization. Subsidiary analyses indicated that, among depressive symptoms, sleep disturbance and fatigue predicted delay.

Conclusion: Depression warrants further attention as a variable that may influence treatment seeking for MI symptoms. Results highlight the need to adequately screen for and treat depression among persons at risk for MI.

Key Words: depression • treatment delay • myocardial infarction • common sense models of illness

Abbreviations: CHD = coronary heart disease; MI = myocardial infarction; PRIME-MD = Primary Care Evaluation of Mental Disorders; PHQ-9 = Depression module of the Patient Health Questionnaire; GI = gastrointestinal; ADL = activities of daily living; LVEF = left ventricular ejection fraction; PVD = peripheral vascular disease.

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