Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis
Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis
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DOI：
10.1176/appi.ajp.163.1.138
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发表时间：
2006-01-01
影响因子：
17.7
通讯作者：
Schene, AH
中科院分区：
文献类型：
--
作者：
de Jonge, P;Ormel, J;Schene, AH
目的：心肌梗塞后抑郁症状的报告可能会与源于心肌梗塞的主诉混淆。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塞后抑郁症状维度与躯体健康状况和前瞻性心血管预后之间的关系。方法：在两项针对心肌梗塞患者（N = 494 和 1,972）的研究中，使用贝克抑郁量表来确定心肌梗塞后抑郁症状的维度结构。将躯体/情感、认知/情感和食欲三个症状维度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。还检查了抑郁症状维度与预期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）。结果：躯体/情感症状与不良健康状况（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）以及预测心血管死亡率和心脏事件相关。认知/情感症状仅与躯体健康状况有轻微相关，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。结论：心肌梗死后的躯体/情感抑郁症状与躯体健康状况混淆，但即使在躯体健康状况得到控制后，也与心脏预后前瞻性相关。认知/情感抑郁症状与健康状况仅略有相关，与心脏预后无关。这些发现表明，心肌梗塞后抑郁症的治疗在减少躯体/情感症状时可能会改善心血管预后。
Objective: 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.Method: 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).Results: 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.Conclusions: 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.