Mental Health Research Group, University of Exeter Medical School, United Kingdom of Great Britain and Northern Ireland.
School of Psychology, University of Exeter, United Kingdom of Great Britain and Northern Ireland.
Gen Hosp Psychiatry. 2019 Nov-Dec;61:16-25. doi: 10.1016/j.genhosppsych.2019.06.012. Epub 2019 Jun 28.
Depression is common in people who have experienced recent Acute Coronary Syndrome (ACS), and predicts worse medical outcomes. Mechanisms underpinning the development of depression and its association with poor medical outcomes are unclear however. The aim of this study was to investigate the role of perseverative negative thinking (e.g. worry and rumination) in predicting depression in people with recent ACS.
Adults attending specialist inpatient and outpatient cardiology services who had recently experienced ACS were invited to participate in this observational prospective cohort study. Questionnaire assessments were completed within 6months of index ACS (baseline), then 2months and 6months later.
169 participants (131 male (78%), median age 68 (±16) years) completed baseline questionnaires, and 111 completed follow-ups. After controlling for the effects of key covariates, baseline rumination was a significant predictor of depression at 6months, accounting for 2% of the variance in depression. This association was partially mediated by poor problem-solving ability and lack of social support. Neither worry nor rumination at baseline were significant predictors of quality of life at 6months.
Rumination is a significant independent predictor of depression, and this association may be partially explained by deficits in problem-solving ability and reduced social support. Both rumination and problem solving may provide useful targets for the development of evidence-based interventions to reduce depression among people with coronary heart disease.
抑郁在经历近期急性冠状动脉综合征（ACS）的人群中很常见，并且预测预后更差。然而，支撑抑郁发展及其与不良医疗结果之间关联的机制尚不清楚。本研究旨在探讨坚持性消极思维（例如担忧和沉思）在预测近期 ACS 患者发生抑郁中的作用。
邀请在最近经历 ACS 后正在专科住院和门诊心内科就诊的成年人参与这项观察性前瞻性队列研究。在 ACS 发作后 6 个月内（基线）进行问卷调查，然后在 2 个月和 6 个月后进行随访。
共有 169 名参与者（131 名男性（78％），中位年龄为 68（±16）岁）完成了基线问卷，其中 111 名参与者完成了随访。在控制了关键协变量的影响后，基线沉思是 6 个月时抑郁的显著预测因素，占抑郁方差的 2％。这种关联部分通过解决问题能力差和缺乏社会支持来解释。基线时的担忧或沉思均不是 6 个月时生活质量的显著预测因素。
沉思是抑郁的一个重要独立预测因素，这种关联可能部分通过解决问题能力下降和社会支持减少来解释。沉思和解决问题能力两者都可能成为为冠心病患者制定基于证据的干预措施，以减少抑郁的有用目标。
