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Post-Myocardial Infarction Depression

Summary

Evidence Report/Technology Assessment: Number 123

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Under its Evidence-based Practice Program, the Agency for Healthcare Research and Quality (AHRQ) is developing scientific information for other agencies and organizations on which to base clinical guidelines, performance measures, and other quality improvement tools. Contractor institutions review all relevant scientific literature on assigned clinical care topics and produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities.

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Introduction / Methods / Results / Discussion / Availability of Full Report / References


Authors: Bush DE, Ziegelstein RC, Patel UV, Thombs BD, Ford DE, Fauerbach JA, McCann UD, Stewart KJ, Tsilidis KK, Patel AL, Feuerstein CJ, Bass EB.

Introduction

Major depression is common among patients recovering from a myocardial infarction (MI).1-5 Additionally, clinically significant depressive symptoms are present in other patients whose symptom severity or duration does not meet established criteria for a diagnosis of major depression.5 Over the last decade, increasing evidence suggests that in addition to its effect on quality of life, post-MI depression also deserves attention because of a reported relation to increased morbidity and mortality.5-8

This evidence report reviews the studies that have examined depression or depressive symptoms in patients after an MI and focuses on the prevalence, clinical significance, treatment, and methods of evaluating this condition. A number of studies have evaluated various aspects of post-MI depression including prevalence,1-4,9-27 its association with mortality,5-10,20,28-36 and major adverse events,25,26,31,37-39 and treatment.10,40-47

This report addresses the following key questions regarding post-MI depression:

  1. In patients diagnosed with and hospitalized for acute MI, what is the prevalence of depression during initial hospitalization for MI? Depression was defined as symptoms of depression meeting established threshold criteria by psychiatric interview or validated questionnaire.
    1. What is the prevalence of depression during initial hospitalization for an acute MI, with and without a history of previous depression as reported by study investigators?
  2. What percentage of patients with post-MI depression continue to have depression (or depressive symptoms) one or more months after initial hospital discharge?
  3. What is the association of post-MI depression with outcomes independent of other predictors of post-MI outcomes? Post-MI outcomes include:
    • Clinical outcomes—total mortality, cardiac mortality, MI, resuscitated arrest, stroke, arrhythmias, and revascularization.
    • Quality of life.
    • Utilization of health care services—readmission, total hospital days, and cost of care. Potential predictors include demographic and clinical characteristics of patients that have been reported to be associated with the risk of post-MI outcomes.
    1. What is the association of post-MI depression with surrogate markers of cardiac risk independent of other predictors of post-MI outcomes? Surrogate markers of disease severity include: heart rate variability, platelet reactivity, and markers of inflammation such as C-reactive protein.
  4. Do post-MI patients with depression have better outcomes with depression treatment compared to those without depression treatment? Depression treatment includes all interventions intended to have specific impact on depression, such as antidepressants, cognitive behavioral therapy, inter-personal therapy, psychosocial support, and cardiac rehabilitation.
    1. Do outcomes differ with or without improvement in depression for post-MI patients with depression that do receive depression treatment?
    2. Do outcomes differ with or without improvement in depression for post-MI patients with depression that do not receive depression treatment?
  5. What are the performance characteristics (e.g., sensitivity, specificity, reliability, and predictive value) of instruments or methods that are used to screen for depression (or depressive symptoms) following an acute MI?
    1. What are the performance characteristics of instruments or methods that are used to screen for depression (or depressive symptoms) following an acute MI, during hospitalization?
    2. What are the performance characteristics of instruments or methods that are used to screen for depression (or depressive symptoms) following an acute MI, within three months after hospitalization?
  6. Does the use of cardiac treatment for patients with acute MI differ for those with and without depression? Cardiac treatment includes: revascularization (angioplasty or bypass surgery), angiotensin converting enzyme (ACE) inhibitors, beta blockers, statins, antiplatelet agents, or other treatments recommended by the American Heart Association or the American College of Cardiology.

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Methods

The Johns Hopkins University Evidence-based Practice Center (EPC) assembled a team including clinicians and researchers from diverse specialties including cardiology, psychiatry, general internal medicine, and cardiac rehabilitation. The EPC team then recruited eight technical experts to provide input regarding the choice of key questions. The expert review panel consisted of a representative from the EPC's partner organization, the American Academy of Family Physicians, as well as investigators active in post-MI depression research including those from cardiology, psychiatry and psychology, nursing, cardiac rehabilitation, and representatives of private and governmental payers.

Literature Search

The EPC team performed a comprehensive search that included electronic and hand searching. In March 2004, we searched the following electronic databases: MEDLINE®, the Cochrane CENTRAL® Register of Controlled Trials (Issue 1, 2003), the Cochrane Database of Methodology Reviews (CDMR®), the Cumulative Index of Nursing and Allied Health Literature (CINAHL®), the Psychological Abstracts (PsycINFO®), and EMBASE®.

Hand searching for possibly relevant articles was performed by three techniques. First, the EPC team identified 16 journals that we thought were most likely to contain relevant studies and scanned the table of contents of each of these journals for relevant citations from October 2003 to April 2004. Second, we reviewed references cited in recent review articles for inclusion. Third we examined the reference lists of eligible articles for additional articles that might be relevant.

Two members of the EPC team independently reviewed the abstracts identified by the search to exclude those that did not meet the eligibility criteria. Primary studies were eligible if they addressed one of the key questions, included original human data, were not case reports, and were written in the English language. Individual key questions had additional exclusion criteria. When two reviewers agreed that an abstract was not eligible, it was excluded from further review.

To focus the evidence report on the studies that would be most valuable in addressing the key questions, we used the following additional eligibility criteria:

  • For key question 4 we excluded studies that did not include a concurrent comparison group.
  • For key question 5, we excluded studies that did not use a validated reference standard.

Review Process

Paired reviewers assessed the quality of each eligible article. Differences between the paired reviewers were resolved by face-to-face discussion. The reviewers assigned points for the quality of the studies based on:

  • Information about the representativeness of the patients included in the study.
  • The potential for bias and confounding.
  • The description of the intervention or evaluation.
  • The adequacy of followup.
  • The appropriateness of the statistical methods.

The score for each category of study quality was the percentage of the total points available in each category for that study, and could range from zero to 100 percent.

One reviewer in each pair was the primary reviewer who abstracted data from the article. The second reviewer confirmed the accuracy of the first reviewer's work.

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Results

Key Question 1

In patients diagnosed with and hospitalized for acute MI what is the prevalence of depression during initial hospitalization for MI?

  • Twenty-five articles met criteria for inclusion in this review.1-5,9-27,48
  • Articles were published between 1986 and 2004.
  • Eight studies used a structured clinical interview,1-3,5,10,16,17,49 and 17 used a validated questionnaire.4,5,9,11-15,18-25,50
  • Major depression was reported in about one of every five patients hospitalized for an MI. The reported prevalence of potentially significant symptoms of depression varied widely (range 10 to 47 percent).
  • In general, the reported prevalence of potentially significant symptoms of depression was higher when it was based on a Beck Depression Inventory (BDI)5,9,18-23,50 than when based on a Hospital Anxiety and Depression Scale (HADS);12-15 this may be because the BDI includes somatic symptoms that may overlap with MI symptoms, whereas the HADS does not.

Key Question 1a

What is the prevalence of depression during initial hospitalization for an acute MI, with and without a history of previous depression as reported by study investigators?

There was insufficient data to address this question.

Key Question 2

What percentage of patients with post-MI depression continues to have depression (or depressive symptoms) one or more months after initial hospital discharge?

  • We found 22 articles that met criteria for inclusion in this review.2,12,14,18-20,22,23,25,26,38,51-61
  • Nine of the 22 used a standardized clinical interview to diagnose depression.10,26,51-57
  • Only three studies reported the prevalence of depression in patients during the MI hospitalization and then specifically re-assessed and reported the prevalence in these same patients at followup.2,18,23
  • Based on these three studies, most patients with depression during the initial MI hospitalization continue to have depression 1 to 4 months later.

Key Question 3

What is the association of post-MI depression with outcomes independent of other predictors of post-MI outcomes?

  • Sixteen studies addressed the relationship of post-MI depression and mortality.5-10,20,28-36
  • Mortality has been assessed as early as 4 months5 and as late as 10 years after MI.7
  • The evidence indicates that post-MI depression is associated with a significantly increased risk of death.
  • A single study indicated that post-MI depression is associated with increased cardiac re-admission in the first year after MI.39
  • Six studies reported on cardiac events in relationship to post-MI depression.25,26,31,37-39 The three studies reporting a positive relationship between post-MI depression and cardiac events31,37,39 were generally larger than the three studies finding no relationship25,26,38 suggesting that the latter may have had insufficient power to detect differences if they, in fact, were present.
  • Depression during the initial hospitalization was related to poor quality of life in the first year after MI.13,30,59,62

Key Question 3a

What is the association of post-MI depression with surrogate markers of cardiac risk independent of other predictors of post-MI outcomes?

  • Three studies examined the association of post-MI depression with heart rate variability, platelet activity, and inflammatory markers (one study for each surrogate marker).57,63,64
  • All three studies reported surrogate markers of increased risk in patients with post-MI depression, even after adjustment for covariates.

Key Question 4

Do post-MI patients with depression have better outcomes with depression treatment compared to those without depression treatment?

  • Twelve studies, 11 of which were randomized controlled trials, addressed this question.10,40-47,65-67 The studies were published between 1991 and 2003.
  • In post-MI patients with depression, psychosocial intervention improves depression but not other outcomes.10,44
  • In post-MI patients with depression, selective serotonin reuptake inhibitors improve depression and some surrogate markers of cardiac risk, but no studies of sufficient power address the question of whether this treatment improves survival.45,46,65,66

Key Question 4a

Do outcomes differ with or without improvement in depression for post-MI patients with depression that do receive depression treatment?

There was insufficient data to address this question.

Key Question 4b

Do outcomes differ with or without improvement in depression for post-MI patients with depression that do not receive depression treatment?

There was insufficient data to address this question.

Key Question 5

What are the performance characteristics (e.g., sensitivity, specificity, reliability, and predictive value) of instruments or methods that are used to screen for depression (or depressive symptoms) following an acute MI?

  • We found six studies published between 1968 and 1988 meeting criteria to address this issue.14,18,56,68-70
  • Of the six studies, four were from Europe,14,56,68,70 one from Canada18 and one from the United States.69
  • All included studies reported exclusively on post-MI populations.
  • None of the instruments reported had been normalized specifically for post-MI patients.
  • The BDI tended to be more sensitive to lower levels of depressive symptoms but less sensitive to more severe depression compared to the HADS and the Symptom Checklist-90 Depression scale.

Key Question 5a

What are the performance characteristics of instruments or methods that are used to screen for depression (or depressive symptoms) following an acute MI during hospitalization?

There was insufficient data to address this question.

Key Question 5b

What are the performance characteristics of instruments or methods that are used to screen for depression (or depressive symptoms) following an acute MI, within three months after hospitalization?

There was insufficient data to address this question.

Key Question 6

Does the use of cardiac treatment for patients with acute MI differ for those with and without depression?

  • Nine studies published between 1982 and 2004 met criteria for review on this question. 23,26,37,50,71-75
  • Four studies compared prescribed discharge medications and were inconsistent in their findings: United States and United Kingdom50,71 studies suggested decreased prescriptions of beta-blockers and aspirin, while European26 and Canadian23 studies found no difference.
  • Three studies compared adherence to prescribed medications and lifestyle modifications and consistently found decreased adherence among depressed patients.71-73
  • Two studies compared use of cardiac procedures and reached divergent conclusions about the use of procedures in post-MI patients.23,37
  • Two studies assessed completion of cardiac rehabilitation but had insufficient numbers to reach conclusions about the influence of depression on completion of rehabilitation.74,76

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Discussion

Key Question 1

Major depression is reported in about one of every five patients hospitalized for MI. This proportion is fairly consistent among the eight studies that used a structured clinical interview to establish this diagnosis. The reported prevalence of potentially significant symptoms of depression varies more widely (range 10 to 47 percent).

This wide range of reported prevalence rates appears to be due almost exclusively to differences in measurement instruments used, and even to differences in threshold criteria applied from study to study when the same instrument was used. In general, the reported prevalence of potentially significant symptoms of depression is higher when this diagnosis is based on a BDI score of 10 or higher than when it is based on a HADS score of either 8 or higher or 11 or higher. This difference may be attributed to the BDI's inclusion of somatic symptoms that may overlap with MI symptoms, whereas the HADS does not include somatic symptoms and is designed for use in hospitalized patients.

Additional studies also are needed to define the most clinically-relevant measure of depression during the initial MI hospitalization. Studies are needed to determine the clinical or demographic factors that are associated with post-MI depression.

Key Question 2

Although 22 studies reported the prevalence of depression in patients 1 month or longer after initial hospital discharge, only three reported the prevalence of depression in patients during the MI hospitalization and then specifically reassessed and reported the prevalence of depression in these same patients at followup. These studies suggest that most patients (60 to 70 percent) with depression during the initial MI hospitalization continue to have depression (or depressive symptoms) 1 to 4 months later.

Additional studies are needed that assess depression (or depressive symptoms) in groups of patients during the initial hospitalization and at various time points after MI. Studies of patients who are reassessed for depression at multiple time points post-MI are also needed.

Key Question 3

Sixteen studies evaluated the relationship between depression, measured shortly after an acute MI, and subsequent mortality. Studies have assessed this relationship as early as 4 months post-MI and as late as 10 years post-MI. Despite the facts that various measures of depression have been used, that different subgroups of depressed patients have been evaluated, and that different post-MI survival times have been assessed, the weight of the evidence is strikingly consistent.

Overall, the evidence supports the notion that post-MI depression is associated with a significantly increased risk for subsequent death, whether by cardiac or other causes. Depression appears to be associated with about a 3-fold increased risk of cardiac mortality per se based on at least three studies that addressed cardiac mortality in a total of almost 2,000 patients.39,77,78 Depression during the initial hospitalization is associated with poor quality of life in the first year after an MI.

During the first year after MI, depression during the initial MI hospitalization has been found to be inversely related to physical quality of life, social quality of life of women, sexual activity and satisfaction among men, return to work of employed men, and to physical, psychological, and social health and function.

Limitations of the above mentioned studies included:

  • Variety of diagnostic instruments used to assess depression.
  • Lack of agreement on what aspects of quality of life are of greatest import or how to measure included studies.
  • The degree to which potential confounders were adequately considered.
  • Absence of data in early post-MI time points.

Additional studies are needed to determine the major cause(s) of mortality among depressed post-MI patients. Additional studies also are needed to determine whether patients with depression are at higher risk for malignant arrhythmias than comparable post-MI patients without depression.

Key Question 3a

A small amount of evidence suggests that post-MI patients with depression have alterations in autonomic function as reflected by decreased heart rate variability, increased platelet activity, and increased levels of soluble adhesion molecule 4. These studies suggest that the risk associated with post-MI depression could be transmitted by multiple biological pathways.

Additional studies are needed to elucidate the mechanism(s) responsible for increased mortality in patients with post-MI depression. Particular emphasis should be placed on surrogate markers which have been previously associated with increased risk without regard to depression, including markers for sudden death including heart rate variability, T-wave alternans, etc, and inflammatory markers including C-reactive protein, interleukins, adhesion molecules and others. Studies are needed that evaluate the hemostatic and platelet function of patients with post-MI depression.

Future studies also should address whether responses to commonly used antiplatelet agents differ among post-MI patients with versus without depression.

Key Question 4

No studies of sufficient power have yet been performed that directly address the question as to whether treatment with antidepressants improves survival in depressed patients after an MI. Some evidence suggests that selective serotonin reuptake inhibitor antidepressants have beneficial effects on surrogate markers of post-MI risk (e.g., heart rate variability, aortic time velocity integral). There is evidence that both psychosocial intervention and selective serotonin reuptake inhibitor antidepressants improve depression in post-MI patients. However, the possibility of increases in rare adverse events cannot be excluded.

Studies are needed to determine whether patients with depression who are treated for depression, especially with highly effective drugs, differ in outcomes from patients who are not treated. Future studies should also determine whether treatment for depression per se or resolution of depression is associated with different outcomes.

Key Question 5

There are insufficient data to allow an adequate assessment of the performance characteristics of instruments or methods used to screen for depression during the initial MI hospitalization. The very low positive predictive values of these screening instruments (generally in the 25 to 50 percent range) may be acceptable clinically if followed by a more thorough assessment of those who screen positive; however, the low positive predictive values are particularly problematic if used to detect relationships to outcome variables in the research setting.

When compared with the HADS and Symptom Checklist-90 Depression scale, the BDI tends to diagnose less significant symptoms of depression at higher rates. It may be less effective in accurately diagnosing major depression.

Additional studies are needed to determine the performance characteristics of instruments or methods used to screen for depression (or depressive symptoms) during the initial MI hospitalization. Studies are needed in post-MI patients that examine the ability for depression screening instruments or methods to distinguish symptoms of depression from symptoms attributable to the MI, to poor physical health, or to the hospitalization itself.

Key Question 6

It remains unclear whether there are significant differences in cardiac medications prescribed to post-MI patients based on the presence or absence of depression. Three studies evaluated adherence to prescribed medications and secondary prevention measures in post-MI patients and consistently found lower adherence in those with depression than those without depression. Two good-quality studies, using different methods, came to diverse conclusions about whether the frequency with which cardiac procedures are used varies between post-MI patients with depression and those without depression.

Additional large studies are needed to examine whether the use of diagnostic and therapeutic procedures differs between depressed and non-depressed post-MI patients. Future studies should also address whether potential differences in procedures are due to differences in provider recommendation or to differences in patient acceptance. Further studies are needed to determine whether the treatment prescribed to post-MI patients with depression differs from those without depression. Future studies should address whether the non-pharmacologic interventions (including diet, exercise and cardiac rehabilitation) recommended to post-MI patients differ between those patients with and without post-MI depression. Future studies should examine the adherence behavior of post-MI patients and evaluate measures that could improve adherence to recommended treatment.

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Availability of Full Report

The full evidence report from which this summary was taken was prepared for the Agency for Healthcare Research and Quality (AHRQ) by The Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018. Printed copies may be obtained free of charge from the AHRQ Publications Clearinghouse by calling 800-358-9295. Requesters should ask for Evidence Report/Technology Assessment No. 123, Post-Myocardial Infarction Depression.

The Evidence Report is also online on the National Library of Medicine Bookshelf, or can be downloaded as a PDF File (1.8 MB). Plugin Software Help.

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References

1. Carney RM, Freedland KE, Jaffe AS. Insomnia and depression prior to myocardial infarction. Psychosom Med 1990;52(6):603-9.

2. Schleifer SJ, Slater WR, Macari-Hinson MM, et al. Digitalis and beta-blocking agents: effects on depression following myocardial infarction. Am Heart J 1991;121(5):1397-402.

3. Watkins LL, Blumenthal JA, Carney RM. Association of anxiety with reduced baroreflex cardiac control in patients after acute myocardial infarction. Am Heart J 2002;143(3):460-6.

4. Taylor CB, Houston-Miller N, Ahn DK, et al. The effects of exercise training programs on psychosocial improvement in uncomplicated postmyocardial infarction patients. J Psychosom Res 1986;30(5):581-7.

5. Bush DE, Ziegelstein RC, Tayback M, et al. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol 2001;88(4):337-41.

6. Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival. JAMA 1993;270(15):1819-25.

7. Frasure-Smith N, Lesperance F, Juneau M, et al. Gender, depression, and one-year prognosis after myocardial infarction. Psychosom Med 1999;61(1):26-37.

8. Carney RM, Blumenthal JA, Catellier D, et al. Depression as a risk factor for mortality after acute myocardial infarction. Am J Cardiol 2003;92(11):1277-81.

9. Lesperance F, Frasure-Smith N, Talajic M, et al. Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation 2002;105(9):1049-53.

10. Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) randomized trial. JAMA 2003;289(23):3106-16.

11. O'Rourke A, Hampson SE. Psychosocial outcomes after an MI: an evaluation of two approaches to rehabilitation. Psychol Health & Med 1999;4(4):393-402.

12. Bennett P, Mayfield T. Mood and behaviour change following first myocardial infarction. Coronary Health Care 1998;2(4):210-4.

13. Mayou RA, Gill D, Thompson DR, et al. Depression and anxiety as predictors of outcome after myocardial infarction. Psychosom Med 2000;62(2):212-9.

14. Martin CR, Lewin RJ, Thompson DR. A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychiatry Res 2003;120(1):85-94.

15. Brink E, Karlson BW, Hallberg LR. Health experiences of first-time myocardial infarction: factors influencing women's and men's health-related quality of life after five months. Psychol Health & Med 2002;7(1):5-16.

16. Forrester AW, Lipsey JR, Teitelbaum ML, et al. Depression following myocardial infarction. Int J Psychiatry Med 1992;22(1):33-46.

17. Rafanelli C, Roncuzzi R, Finos L, et al. Psychological assessment in cardiac rehabilitation. Psychother Psychosom 2003;72(6):343-9.

18. Davis T, Jensen L. Identifying depression in medical patients. Image J Nurs Sch 1988;20(4):191-5.

19. Legault SE, Joffe RT, Armstrong PW. Psychiatric morbidity during the early phase of coronary care for myocardial infarction: association with cardiac diagnosis and outcome. Can J Psychiatry 1992;37(5):316-25.

20. Lane D, Carroll D, Ring C, et al. In-hospital symptoms of depression do not predict mortality 3 years after myocardial infarction. Int J Epidemiol 2002;31(6):1179-82.

21. Barefoot JC, Burg MM, Carney RM, et al. Aspects of social support associated with depression at hospitalization and follow-up assessment among cardiac patients. J Cardiopulm Rehabil 2003;23(6):404-12.

22. Luutonen S, Holm H, Salminen JK, et al. Inadequate treatment of depression after myocardial infarction. Acta Psychiatr Scand 2002;106(6):434-39.

23. Lauzon C, Beck CA, Huynh T, et al. Depression and prognosis following hospital admission because of acute myocardial infarction. Can Med Assoc J 2003;168(5):547-52.

24. Silverstone PH. Changes in depression scores following life-threatening illness. J Psychosom Res 1990;34(6):659-63.

25. Strik JJ, Denollet J, Lousberg R, et al. Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol 2003;42(10):1801-7.

26. Strik JJ, Lousberg R, Cheriex EC, et al. One year cumulative incidence of depression following myocardial infarction and impact on cardiac outcome. J Psychosom Res 2004;56(1):59-66.

27. Gilutz H, Bar-On D, Billing E, et al. The relationship between causal attribution and rehabilitation in patients after their first myocardial infarction. A cross cultural study. Eur Heart J 1991;12(8):883-8.

28. Denollet J, Vaes J, Brutsaert DL. Inadequate response to treatment in coronary heart disease : adverse effects of type D personality and younger age on 5-year prognosis and quality of life. Circulation 2000;102(6):630-5.

29. Welin C, Lappas G, Wilhelmsen L. Independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med 2000;247(6):629-39.

30. Lane D, Carroll D, Ring C, et al. Mortality and quality of life 12 months after myocardial infarction: Effects of depression and anxiety. Psychosom Med 2001;63(2):221-230.

31. Irvine J, Basinski A, Baker B, et al. Depression and risk of sudden cardiac death after acute myocardial infarction: testing for the confounding effects of fatigue. Psychosom Med 1999;61(6):729-37.

32. Lane D, Carroll D, Ring C, et al. Effects of depression and anxiety on mortality and quality-of-life 4 months after myocardial infarction. J Psychosom Res 2000;49(4):229-38.

33. Ahern DK, Gorkin L, Anderson JL, et al. Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS). Am J Cardiol 1990;66(1):59-62.

34. Ladwig KH, Kieser M, Konig J, et al. Affective disorders and survival after acute myocardial infarction. Results from the post-infarction late potential study. Eur Heart J 1991;12(9):959-64.

35. Druss BG, Bradford D, Rosenheck RA, et al. Quality of medical care and excess mortality in older patients with mental disorders. Arch Gen Psychiatry 2001;58(6):565-72.

36. Frasure-Smith N, Lesperance F. Depression and other psychological risks following myocardial infarction. Arch Gen Psychiatry 2003;60(6):627-36.

37. Druss BG, Bradford DW, Rosenheck RA, et al. Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA 2000;283(4):506-11.

38. Shiotani I, Sato H, Kinjo K, et al. Depressive symptoms predict 12-month prognosis in elderly patients with acute myocardial infarction. J Cardiovasc Risk 2002;9(3):153-60.

39. Frasure-Smith N, Lesperance F, Gravel G, et al. Depression and health-care costs during the first year following myocardial infarction. J Psychosom Res 2000;48(4-5):471-8.

40. Brown MA, Munford AM, Munford PR. Behavior therapy of psychological distress in patients after myocardial infarction or coronary bypass. J Cardiopulm Rehabil 1993;13(3):201-10.

41. Crowe JM, Runions J, Ebbesen LS, et al. Anxiety and depression after acute myocardial infarction. Heart Lung 1996;25(2):98-107.

42. Dracup K, Moser DK, Marsden C, et al. Effects of a multidimensional cardiopulmonary rehabilitation program on psychosocial function. Am J Cardiol 1991;68(1):31-4.

43. Frasure-Smith N, Lesperance F, Prince RH, et al. Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. Lancet 1997;350(9076):473-9.

44. Johnston M, Foulkes J, Johnston DW, et al. Impact on patients and partners of inpatient and extended cardiac counseling and rehabilitation: a controlled trial. Psychosom Med 1999;61(2):225-33.

45. Strik JJ, Honig A, Lousberg R, et al. Efficacy and safety of fluoxetine in the treatment of patients with major depression after first myocardial infarction: Findings from a double-blind, placebo-controlled trial. Psychosom Med 2000;62(6):783-9.

46. Glassman AH, O'Connor CM, Califf RM, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002;288(6):701-9.

47. Swenson JR, O'Connor CM, Barton D, et al. Influence of depression and effect of treatment with sertraline on quality of life after hospitalization for acute coronary syndrome. Am J Cardiol 2003;92(11):1271-6.

48. Zotti AM, Bettinardi O, Soffiantino F, et al. Psychophysiological stress testing in postinfarction patients. Psychological correlates of cardiovascular arousal and abnormal cardiac responses. Circulation 1991;83(4 Suppl):II25-35.

49. Kaufmann MW, Fitzgibbons JP, Sussman EJ, et al. Relation between myocardial infarction, depression, hostility, and death. Am Heart J 1999;138(3 Pt 1):549-54.

50. Steeds RP, Bickerton D, Smith MJ, et al. Assessment of depression following acute myocardial infarction using the Beck depression inventory. Heart 2004;90(2):217-8.

51. Aben I, Verhey F, Strik J, et al. A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction. J Neurol Neurosurg Psychiatry 2003;74(5):581-5.

52. Trelawny-Ross C, Russell O. Social and psychological responses to myocardial infarction: multiple determinants of outcome at six months. J Psychosom Res 1987;31(1):125-30.

53. Garcia L, Valdes M, Jodar I, et al. Psychological factors and vulnerability to psychiatric morbidity after myocardial infarction. Psychother Psychosom 1994;61(3-4):187-94.

54. Lesperance F, Frasure-Smith N, Talajic M. Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med 1996;58(2):99-110.

55. Strik JJ, Lousberg R, Crijns HJ, et al. Relation of levels of serum lipoproteins to depression after acute myocardial infarction. Am J Cardiol 2002;90(12):1368-70.

56. Strik JJ, Honig A, Lousberg R, et al. Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction. Psychosomatics 2001;42(5):423-8.

57. Lesperance F, Frasure-Smith N, Theroux P, et al. The association between major depression and levels of soluble intercellular adhesion molecule 1, interleukin-6, and C-reactive protein in patients with recent acute coronary syndromes. Am J Psychiatry 2004;161(2):271-7.

58. Lane D, Carroll D, Ring C, et al. The prevalence and persistence of depression and anxiety following myocardial infarction. Br J Health Psychol 2002;7(1):11-21.

59. Travella JI, Forrester AW, Schultz SK, et al. Depression following myocardial infarction: a one year longitudinal study. Int J Psychiatry Med 1994;24(4):357-69.

60. Clarke DE, Walker JR, Cuddy TE. The role of perceived overprotectiveness in recovery 3 months after myocardial infarction. J Cardiopulm Rehabil 1996;16(6):372-7.

61. Follick MJ, Gorkin L, Smith TW, et al. Quality of life post-myocardial infarction: effects of a transtelephonic coronary intervention system. Health Psychol 1988;7(2):169-82.

62. Drory Y, Kravetz S, Hirschberger G. Long-term mental health of men after a first acute myocardial infarction. Arch Phys Med Rehabil 2002;83(3):352-9.

63. Carney RM, Blumenthal JA, Stein PK, et al. Depression, heart rate variability, and acute myocardial infarction. Circulation 2001;104(17):2024-8.

64. Kuijpers PM, Hamulyak K, Strik JJ, et al. Beta-thromboglobulin and platelet factor 4 levels in post-myocardial infarction patients with major depression. Psychiatry Res 2002;109(2):207-10.

65. Roose SP, Laghrissi-Thode F, Kennedy JS, et al. Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. JAMA 1998;279(4):287-91.

66. McFarlane A, Kamath MV, Fallen EL, et al. Effect of sertraline on the recovery rate of cardiac autonomic function in depressed patients after acute myocardial infarction. Am Heart J 2001;142(4):617-23.

67. Taylor CB, Miller NH, Smith PM, et al. The effect of a home-based, case-managed, multifactorial risk-reduction program on reducing psychological distress in patients with cardiovascular disease. J Cardiopulm Rehabil 1997;17(3):157-62.

68. Martin CR, Thompson DR. A psychometric evaluation of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychol Health Med 2000;5(2):193-201.

69. Freedland KE, Skala JA, Carney RM, et al. The Depression Interview and Structured Hamilton (DISH): rationale, development, characteristics and clinical validity. Psychosom Med 2002;64(6):897-905.

70. Wojciechowski FL, Strik JJ, Falger P, et al. The relationship between depressive and vital exhaustion symptomatology post-myocardial infarction. Acta Psychiatr Scand 2000;102(5):359-65.

71. Conn VS, Taylor SG, Wiman P. Anxiety, depression, quality of life, and self-care among survivors of myocardial infarction. Issues Ment Health Nurs 1991;12(4):321-31.

72. Romanelli J, Fauerbach JA, Bush DE, et al. The significance of depression in older patients after myocardial infarction. J Am Geriatr Soc 2002;50(5):817-22.

73. Schreiber W, Kittler H, Pieper O, et al. Prediction of 24 h, nonfatal complications in patients with acute myocardial infarction receiving thrombolytic therapy by calculation of the ST segment deviation score. Can J Cardiol 2003;19(2):151-7.

74. Blumenthal JA, Williams RS, Wallace AG. Physiological and psychological variables predict compliance to prescribed exercise therapy in patients recovering from myocardial infarction. Psychosom Med 1982;44(6):519-27.

75. Ziegelstein RC, Fauerbach JA, Stevens SS, et al. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med 2000;160(12):1818-23.

76. Whitmarsh A, Koutantji M, Sidell K. Illness perceptions, mood and coping in predicting attendance at cardiac rehabilitation. Br J Health Psychol 2003;8(2):209-21.

77. Stein PK, Carney RM, Freedland KE, et al. Severe depression is associated with markedly reduced heart rate variability in patients with stable coronary heart disease. J Psychosom Res 2000;48(4-5):493-500.

78. Carney RM, Freedland KE, Rich MW, et al. Ventricular tachycardia and psychiatric depression in patients with coronary artery disease. Am J Med 1993;95(1):23-8.

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