Martens E J, Smith O R F, Winter J, Denollet J, Pedersen S S
CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands.
Psychol Med. 2008 Feb;38(2):257-64. doi: 10.1017/S0033291707001377. Epub 2007 Sep 17.
Although many studies have focused on post-myocardial infarction (MI) depression, there is limited information about the evolution and determinants of depressive symptoms in the first year post-MI. Therefore we examined (1) the course of depressive symptoms during the first year post-MI and (2) the predictors of these symptom trajectories.
To assess depressive symptoms, 287 patients completed the Beck Depression Inventory during hospitalization for MI, and 2, and 12 months post-MI. Personality was assessed with the Type-D scale during hospitalization. We used latent class analysis to examine the evolution of depressive symptoms over a 1-year period and multinomial logit regression analyses to examine predictors of these symptom trajectories.
The course of depressive symptoms was stable during the first year post-MI. Four groups were identified and classified as non-depressed [40%, intercept (IC) 2.52], mildly depressed (42%, IC 6.91), moderately depressed (14%, IC 13.73) or severely depressed (4%, IC 24.54). In multivariate analysis, cardiac history (log OR(severe) 2.93, p=0.02; log OR(moderate) 1.81, p=0.02; log OR(mild) 1.46, p=0.01), history of depression (log OR(severe) 4.40, p<0.001; log OR(moderate) 1.97, p=0.03) and Type-D personality (log OR(severe) 4.22, p<0.001; log OR(moderate) = 4.17, p<0.001; log OR(mild) 1.66, p=0.02) were the most prominent risk factors for persistence of depressive symptoms during the first year post-MI.
Symptoms of depression tend to persist during the first year post-MI. Cardiac history, prior depression and Type-D personality were identified as independent risk factors for persistence of depressive symptoms. The results of this study strongly argue for routine psychological screening during hospitalization for acute MI in order to identify patients who are at risk for chronicity of depressive symptoms and its deleterious effects on prognosis.
尽管许多研究都聚焦于心肌梗死（MI）后抑郁，但关于MI后第一年抑郁症状的演变及决定因素的信息有限。因此，我们研究了（1）MI后第一年抑郁症状的发展过程，以及（2）这些症状轨迹的预测因素。
为评估抑郁症状，287例患者在MI住院期间、MI后2个月及12个月时完成了贝克抑郁量表测试。住院期间用D型量表评估人格。我们采用潜在类别分析来研究1年内抑郁症状的演变，并采用多项logit回归分析来研究这些症状轨迹的预测因素。
MI后第一年抑郁症状的发展过程较为稳定。确定了四组并分类为非抑郁组[40%，截距（IC）2.52]、轻度抑郁组（42%，IC 6.91）、中度抑郁组（14%，IC 13.73）或重度抑郁组（4%，IC 24.54）。在多变量分析中，心脏病史（log OR（重度）2.93，p = 0.02；log OR（中度）1.81，p = 0.02；log OR（轻度）1.46，p = 0.01）、抑郁病史（log OR（重度）4.40，p < 0.001；log OR（中度）1.97，p = 0.03）和D型人格（log OR（重度）4.22，p < 0.001；log OR（中度）= 4.17，p < 0.001；log OR（轻度）1.66，p = 0.02）是MI后第一年抑郁症状持续存在的最显著危险因素。
抑郁症状在MI后第一年往往持续存在。心脏病史、既往抑郁和D型人格被确定为抑郁症状持续存在的独立危险因素。本研究结果强烈支持在急性MI住院期间进行常规心理筛查，以便识别有抑郁症状慢性化风险及其对预后有害影响的患者。
