de Jonge Peter, Ormel Johan, van den Brink Rob H S, van Melle Joost P, Spijkerman Titia A, Kuijper Astrid, van Veldhuisen Dirk J, van den Berg Maarten P, Honig Adriaan, Crijns Harry J G M, Schene Aart H
University of Groningen Department of Psychiatry, the Netherlands.
Am J Psychiatry. 2006 Jan;163(1):138-44. doi: 10.1176/appi.ajp.163.1.138.
The reporting of depressive symptoms following myocardial infarction may be confounded by complaints originating from the myocardial infarction. Therefore, it is difficult to estimate the effects of post-myocardial infarction depression and its treatment on cardiovascular prognosis. The authors' goal was to study the relationship between depressive symptom dimensions following myocardial infarction and both somatic health status and prospective cardiovascular prognosis.
In two studies of myocardial infarction patients (N=494 and 1,972), the Beck Depression Inventory was used to determine the dimensional structure of depressive symptoms following myocardial infarction. Three symptom dimensions-somatic/affective, cognitive/affective, and appetitive-were compared with baseline left ventricular ejection fraction, Charlson comorbidity index, Killip class, and previous myocardial infarction. The relationship between depressive symptom dimensions and prospective cardiovascular mortality and cardiac-related readmissions was also examined (mean follow-up duration=2.5 years).
Somatic/affective symptoms were associated with poor health status (left ventricular ejection fraction, Charlson comorbidity index, Killip class, and previous myocardial infarction) and predicted cardiovascular mortality and cardiac events. Cognitive/affective symptoms were only marginally associated with somatic health status and not with cardiovascular death and cardiac events. Appetitive symptoms were related to somatic health status but did not predict cardiovascular death or cardiac events.
Somatic/affective depressive symptoms following myocardial infarction were confounded by somatic health status yet were prospectively associated with cardiac prognosis even after somatic health status was controlled. Cognitive/affective depressive symptoms were only marginally related to health status and not to cardiac prognosis. These findings suggest that treatment of depression following myocardial infarction might improve cardiovascular prognosis when it reduces somatic/affective symptoms.
心肌梗死后抑郁症状的报告可能会受到源自心肌梗死的主诉的混淆。因此，很难估计心肌梗死后抑郁及其治疗对心血管预后的影响。作者的目标是研究心肌梗死后抑郁症状维度与躯体健康状况及前瞻性心血管预后之间的关系。
在两项针对心肌梗死患者的研究（N = 494和1972）中，使用贝克抑郁量表来确定心肌梗死后抑郁症状的维度结构。将三个症状维度——躯体/情感、认知/情感和食欲——与基线左心室射血分数、查尔森合并症指数、Killip分级和既往心肌梗死进行比较。还研究了抑郁症状维度与前瞻性心血管死亡率和心脏相关再入院之间的关系（平均随访时间 = 2.5年）。
躯体/情感症状与健康状况不佳（左心室射血分数、查尔森合并症指数、Killip分级和既往心肌梗死）相关，并可预测心血管死亡率和心脏事件。认知/情感症状仅与躯体健康状况有微弱关联，与心血管死亡和心脏事件无关。食欲症状与躯体健康状况相关，但不能预测心血管死亡或心脏事件。
心肌梗死后的躯体/情感抑郁症状虽受躯体健康状况的混淆，但即使在控制了躯体健康状况后，仍与心脏预后存在前瞻性关联。认知/情感抑郁症状与健康状况仅存在微弱关联，与心脏预后无关。这些发现表明，心肌梗死后抑郁症的治疗若能减轻躯体/情感症状，可能会改善心血管预后。
