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Depression among heart attack survivors can persist for a year after leaving the hospital

From one-fifth to nearly one-third of patients hospitalized for heart attack suffer from significant depression afterwards, according to a recent review of studies on the topic. A significant proportion of these patients continue to be depressed in the year after they leave the hospital. Patients who have had a heart attack and also have depression are more likely to have unhealthy blood thickening, are less likely to comply with therapy, and are more likely to die than their counterparts without depression.

Thus, screening hospitalized heart attack patients for depression seems like a good idea, but screening results will differ considerably, depending on the method of depression screening used. Structured interviews identified major depression in 1 in 5 patients (20 percent). The Beck Depression Inventory identified mild-to-moderate depression (score of 10) in 1 in 3 patients (31 percent). Using a Hospital Anxiety and Depression Scale (HADS) score of 8 percent or more, 15.5 percent of heart attack patients had possible clinically significant depression. An HADS score of 11 percent or more identified 7.3 percent with probable clinically significant depression.

It seems reasonable to use a validated questionnaire to screen heart attack patients for symptoms of depression while they are hospitalized, and then to assess patients who screen positive using a structured clinical interview, suggest the researchers. Although a substantial proportion of patients continued to be depressed in the year after discharge, only four studies examined this issue. The findings were based on a systematic review of research studies on the prevalence of depression among heart attack survivors that were published from 1980 through April 2004, and included data on more than 14,000 patients. The study was supported by the Agency for Healthcare Research and Quality (290-02-0018).

More details are in "Prevalence of depression in survivors of acute myocardial infarction: Review of the evidence," by Brett D. Thombs, Ph.D., Eric B. Bass, M.D., M.P.H., Daniel E. Ford, M.D., and others, in the January 2006 Journal of General Internal Medicine 21, pp. 30-38.

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