Somatic/affective symptoms, but not cognitive/affective symptoms, of depression after acute coronary syndrome are associated with 12-month all-cause mortality

Abstract

Background: Symptom dimensions of post myocardial infarction (MI) depression may be differently related to prognosis. Somatic/affective symptoms appear to be associated with a worse cardiac outcome than cognitive/affective symptoms. We examined the relationship between depressive symptom dimensions following acute coronary syndrome (ACS) and both disease severity and all-cause mortality.

Methods: Patients (n=913) who had unstable angina pectoris or MI were recruited from 12 coronary care units between 1997 and 1999. Measurements included sociodemographic and clinical data and the Beck Depression Inventory (BDI). Endpoint was all-cause mortality at 12-month follow-up.

Results: Principal component analysis revealed two components, somatic/affective and cognitive/affective symptoms of depression. Somatic/affective symptoms of depression (odds ratio (OR): 1.49; 95% confidence interval (CI): 1.23-1.81; p<0.001) but not cognitive/affective symptoms (OR: 0.92; 95% CI: 0.75-1.12; p=0.40) were related to a higher Killip class. Fifty-one patients died during the follow-up period. When controlling for index event, history of MI, Killip class, diabetes, gender and age, there was a significant association between the somatic/affective component (OR: 1.92; 95% CI: 1.36-2.71; p<0.001) and mortality. The cognitive/affective component was not related to mortality (OR: 1.07; 95% CI: 0.75-1.52; p=0.73).

Limitations: Time to death was not available.

Conclusions: This study showed that only somatic/affective depressive symptoms were associated with disease severity and all-cause mortality in ACS patients. More research is needed to evaluate the differential associations of somatic/affective and cognitive/affective depressive symptoms with cardiac outcomes and the underlying mechanisms.