Dept. of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Psychosom Res. 2012 Jan;72(1):5-10. doi: 10.1016/j.jpsychores.2011.09.009. Epub 2011 Oct 20.
Depression is prevalent in the aftermath of myocardial infarction (MI), and has been linked with mortality however few studies have investigated hospital admissions in MI survivors. Using a prospective cohort design, we examined the long-term relationship between depressive symptoms, post-MI hospital admissions and secondary prevention measures, in order to assess the burden of post-MI depression on patients and the healthcare system.
A cohort of 632 patients aged ≤65 years, admitted for first-ever MI to 1 of the 8 hospitals in central Israel, was followed up for 10-13 years. Depressive symptoms were assessed at initial hospitalization using the Beck Depression Inventory. Rehospitalization and adoption of secondary prevention measures were recorded throughout follow-up.
Depressive symptoms were significantly associated with days of hospitalization during follow-up (RR, 1.37, CI, 1.26-1.49), an association which remained significant after risk adjustment (RR, 1.14, CI, 1.04-1.26). The association appeared stronger for cardiac-related admissions than for other, non-cardiac admissions. Depressed patients were less likely to stop smoking (OR, 0.75, CI, 0.60-0.94), be physically active (OR, 0.80, CI, 0.69-0.94) and participate in cardiac rehabilitation (OR, 0.74, CI, 0.59-0.92).
Post-MI depressive symptoms were shown to be associated with increased hospital admissions, particularly cardiac admissions, and with reduced adoption of secondary prevention behaviors. These findings have implications for patients' prognosis and quality of life and for healthcare costs. Depressive symptoms, even at the sub-clinical level, should be monitored in post-MI patients in order to identify those at greater risk of rehospitalization.
心肌梗死后（MI）普遍存在抑郁症状，并且与死亡率有关，但是很少有研究调查 MI 幸存者的住院情况。本研究采用前瞻性队列设计，旨在研究抑郁症状与 MI 后住院和二级预防措施之间的长期关系，以评估 MI 后抑郁对患者和医疗保健系统的负担。
本研究纳入了年龄≤65 岁的 632 名首次因 MI 入住以色列中部 8 家医院之一的患者，对其进行了 10-13 年的随访。使用贝克抑郁量表（Beck Depression Inventory）在初始住院时评估抑郁症状。在随访期间记录再住院和二级预防措施的采用情况。
抑郁症状与随访期间的住院天数显著相关（RR，1.37，95%CI，1.26-1.49），风险调整后仍然具有统计学意义（RR，1.14，95%CI，1.04-1.26）。这种关联在与心脏相关的住院治疗中比在其他非心脏相关的住院治疗中更为明显。抑郁患者停止吸烟（OR，0.75，95%CI，0.60-0.94）、进行体育锻炼（OR，0.80，95%CI，0.69-0.94）和参加心脏康复（OR，0.74，95%CI，0.59-0.92）的可能性较小。
MI 后抑郁症状与住院增加相关，尤其是心脏相关住院增加，与二级预防行为的采用减少相关。这些发现对患者的预后和生活质量以及医疗保健成本具有重要意义。即使在亚临床水平，也应监测 MI 后患者的抑郁症状，以识别那些再住院风险较高的患者。
