Strik Jacqueline J M H, Lousberg Richel, Cheriex Emile C, Honig Adriaan
Department of Psychiatry, Academic Hospital Maastricht, University of Maastricht, PO Box 5800, Maastricht, 2002 AZ, The Netherlands.
J Psychosom Res. 2004 Jan;56(1):59-66. doi: 10.1016/S0022-3999(03)00380-5.
Major depression has been identified as an independent risk factor for increased morbidity and mortality in mixed patients populations with first and recurrent myocardial infarction (MI). The aim of this study was to evaluate whether incidence of major and minor depression is as high in a population with merely first-MI patients as in recurrent MI populations. Furthermore, it was evaluated whether in first-MI patients major and minor depression, and depressive symptoms, had an impact on cardiac mortality and morbidity up to 3 years post MI.
A consecutive cohort of 206 patients with a first MI were included in this study. One month following MI, all patients were interviewed using the Structured Clinical Interview for DSM-IV (SCID-I-R). Three, six, nine and twelve months following MI, patients filled out three psychiatric self-rating scales for depression, the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the 90-item Symptom Checklist (SCL-90). Patients, exceeding a previously defined cut-off value on at least one of these scales, were reinterviewed using the SCID. The BDI was applied to assess depressive symptoms in relation to cardiac outcome as the SCL-90 and HADS showed similar results. Cardiac outcome was defined as major cardiac event, i.e., death or recurrent MI, and health care consumption, i.e., cardiac rehospitalisation and/or frequent visits at the cardiac outpatient clinic. Depression outcome was assessed from 1 month post MI up to 1 year post MI whereas cardiac outcome was assessed between 1 month and 3 years post MI.
A 1-year incidence of 31% of major and minor depression was found in first-MI patients. The highest incidence rate for both major and minor depression was found in the first month after MI. Compared with nondepressed patients, depressed patients were younger (P=.001), female (P=.04) and were known with a previous depressive episode (P=.002). Neither major/minor depression nor depressive symptoms significantly predicted major cardiac events, but did predict health care consumption (P=.04 and P<.001, respectively).
Incidence of major and minor depression is similar in this first-MI patients population as in recurrent MI populations. Major/minor depressive disorder nor depressive symptoms predicted neither mortality nor reinfarction.
在首次心肌梗死（MI）和复发性心肌梗死的混合患者群体中，重度抑郁症已被确定为发病率和死亡率增加的独立危险因素。本研究的目的是评估仅首次发生心肌梗死的患者群体中重度和轻度抑郁症的发病率是否与复发性心肌梗死群体中的发病率一样高。此外，还评估了在首次心肌梗死患者中，重度和轻度抑郁症以及抑郁症状对心肌梗死后3年内心脏死亡率和发病率是否有影响。
本研究纳入了连续的206例首次发生心肌梗死的患者队列。心肌梗死后1个月，所有患者均使用《精神疾病诊断与统计手册》第四版（DSM-IV）的结构化临床访谈（SCID-I-R）进行访谈。心肌梗死后3、6、9和12个月，患者填写三份抑郁症的精神科自评量表，即贝克抑郁量表（BDI）、医院焦虑抑郁量表（HADS）和90项症状清单（SCL-90）。在这些量表中至少有一项超过先前定义的临界值的患者，再次使用SCID进行访谈。由于SCL-90和HADS显示出相似的结果，因此应用BDI来评估与心脏结局相关的抑郁症状。心脏结局定义为重大心脏事件，即死亡或复发性心肌梗死，以及医疗保健消耗，即心脏再住院和/或频繁到心脏门诊就诊。抑郁结局在心肌梗死后1个月至1年进行评估，而心脏结局在心肌梗死后1个月至3年进行评估。
首次心肌梗死患者中重度和轻度抑郁症的1年发病率为31%。重度和轻度抑郁症的最高发病率均出现在心肌梗死后的第一个月。与非抑郁症患者相比，抑郁症患者更年轻（P = 0.001）、女性（P = 0.04）且有既往抑郁发作史（P = 0.002）。重度/轻度抑郁症和抑郁症状均未显著预测重大心脏事件，但确实预测了医疗保健消耗（分别为P = 0.04和P < 0.001）。
在首次心肌梗死患者群体中，重度和轻度抑郁症的发病率与复发性心肌梗死群体中的发病率相似。重度/轻度抑郁症和抑郁症状既不能预测死亡率，也不能预测再梗死。
