Effects of Depression on Short-Term Recovery from MI

描述(申请人提供)：在对急性心肌梗死后抑郁的预后重要性和治疗进行了十多年的研究后，令人惊讶的是，人们对抑郁障碍的易感性、抑郁症的特征和短期病程以及关键的心血管风险标记物在心肌梗死后恢复期间是否与抑郁同步变化知之甚少。急性心肌梗死后的前6个月是再梗塞或死亡风险最高的时期，但我们对这段时间内抑郁症的病程和影响知之甚少。这项研究将详细描述抑郁症及其在这一关键时期的影响。DISH抑郁症访谈将在急性心肌梗死后一周内对一系列住院患者进行；此时还将抽取血液样本进行5-HTTLPR基因分型。纵向阶段的招募将继续进行，直到400名患者入选(100名重度抑郁症患者，100名轻度抑郁症患者，100名目前没有抑郁症但有重度抑郁症病史的患者，100名从未抑郁过的患者)。将在基线和3个月和6个月的后续会议上亲自进行DISH，并在中期评估时通过电话(每周至第3个月和每月至第6个月)进行。在这些时间将进行额外的访谈模块和问卷调查，以评估抑郁、焦虑、感知到的压力、应激生活事件、健康行为和感受到的社会支持。在基线、3个月和6个月时，抽取血液样本进行炎症和促凝血标志物检测，并采集24小时心电图进行心率变异性分析。计划中的分析将确定心肌梗死后抑郁的独立预测因素，区分快速缓解和持续病例，并模拟抑郁症随时间的变化与心血管风险标记物变化之间的关系。抑郁对再梗塞和存活率的影响将在探索性分析中进行检验。这一结果将阐明心肌梗死后抑郁的早期过程以及将抑郁与心脏事件联系起来的机制，并将为开发更有效的治疗方法提供信息。

DESCRIPTION (provided by applicant): After more than a decade of research on the prognostic importance and treatment of depression after acute MI, surprisingly little is known about vulnerability to depressive disorders, the characteristics and short-term course of depression, and whether key cardiovascular risk markers covary with depression during post-MI recovery. The first 6 months after acute MI is the period of highest risk for reinfarction or mortality, yet we know little about the course and effects of depression during this interval. This study will yield a detailed account of depression and its effects during this critical period. The DISH depression interview will be administered to a series of hospitalized patients within 1 week of an acute MI; a blood sample for 5-HTTLPR genotyping will also be drawn at this time. Enrollment in the longitudinal phase will continue until 400 patients have been enrolled (100 with major depression, 100 with minor depression, 100 currently non-depressed but with a history of major depression, 100 never depressed.) The DISH will be administered in person at baseline and at 3-month and 6-month follow-up sessions, and by telephone at interim assessments (weekly through Month 3 and monthly through Month 6). Additional interview modules and questionnaires will be administered at these times to assess depression, anxiety, perceived stress, stressful life events, health behaviors, and perceived social support. At baseline, 3too, and 6mo, blood samples will be drawn for inflammatory and procoagulant markers, and 24 hr ECGs will be obtained for heart rate variability analysis. Planned analyses will identify independent predictors of post-MI depression, differentiate between rapidly remitting vs. persistent cases, and model the relationships among change over time in depression and change in cardiovascular risk markers. The effects of depression on reinfarction and survival will be examined in exploratory analyses. The results will clarify the early course of post-MI depression and the mechanisms linking depression to cardiac events, and they will inform efforts to develop more efficacious treatments.