Cognitive-affective symptoms of depression after myocardial infarction

Different prognostic importance across age groups

J. Denollet, K.E. Freedland, R.M. Carney, P. de Jonge, A.M. Roest

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objective:
Cognitive-affective symptoms of depression may not be as strongly related to prognosis after myocardial infarction (MI) as somatic depressive symptoms. Because it is not known whether this pattern of results is influenced by the age at which patients are diagnosed as having MI, we examined whether the importance of these symptoms is age dependent in the Enhancing Recovery in Coronary Heart Disease study.
Methods:
Patients with depression after MI (n = 1823) in the Enhancing Recovery in Coronary Heart Disease study were stratified into the following age groups: younger than 70 years (mean [standard deviation] = 55 [9.0] years) and 70 years or older (mean [standard deviation] = 76 [4.9] years). Measurements included demographic and clinical data and the Beck Depression Inventory. The end point was a composite of recurrent MI and mortality during a mean follow-up of 2.1 years.Results: Patients 70 years or older had more severe manifestations of cardiac disease and somatic comorbidities than did patients younger than 70 years (p < .001). During follow-up, 456 patients died or had a recurrent MI. In patients 70 years or older, increasing age, disease severity, and comorbidities—but not depressive symptoms—independently predicted prognosis. In contrast, cognitive-affective symptoms of depression predicted death/MI in patients younger than 70 years (hazard ratio = 1.03, 95% confidence interval = 1.01–1.04, p = .011), after adjustment for disease severity and comorbidities. Somatic symptoms largely explained the link between cognitive-affective symptoms and adverse events, with the exception of hopelessness (hazard ratio = 1.47, 95% confidence interval = 1.11–1.95, p = .007), suggesting that somatic depressive symptoms accurately reflect the depressed mood state in this age group.
Conclusions:
Somatic symptoms and hopelessness independently predicted death/MI in MI patients younger than 70 years. Research needs to reexamine the modulating effect of age in studies on somatic and cognitive-affective symptoms of post-MI depression.
Original languageEnglish
Pages (from-to)701-708
JournalPsychosomatic Medicine
Volume75
Issue number7
DOIs
Publication statusPublished - 2013

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Affective Symptoms
Age Groups
Depression
Comorbidity
Confidence Intervals
Equipment and Supplies
Medically Unexplained Symptoms

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Denollet, J. ; Freedland, K.E. ; Carney, R.M. ; de Jonge, P. ; Roest, A.M. / Cognitive-affective symptoms of depression after myocardial infarction : Different prognostic importance across age groups. In: Psychosomatic Medicine. 2013 ; Vol. 75, No. 7. pp. 701-708.
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abstract = "Objective: Cognitive-affective symptoms of depression may not be as strongly related to prognosis after myocardial infarction (MI) as somatic depressive symptoms. Because it is not known whether this pattern of results is influenced by the age at which patients are diagnosed as having MI, we examined whether the importance of these symptoms is age dependent in the Enhancing Recovery in Coronary Heart Disease study.Methods: Patients with depression after MI (n = 1823) in the Enhancing Recovery in Coronary Heart Disease study were stratified into the following age groups: younger than 70 years (mean [standard deviation] = 55 [9.0] years) and 70 years or older (mean [standard deviation] = 76 [4.9] years). Measurements included demographic and clinical data and the Beck Depression Inventory. The end point was a composite of recurrent MI and mortality during a mean follow-up of 2.1 years.Results: Patients 70 years or older had more severe manifestations of cardiac disease and somatic comorbidities than did patients younger than 70 years (p < .001). During follow-up, 456 patients died or had a recurrent MI. In patients 70 years or older, increasing age, disease severity, and comorbidities—but not depressive symptoms—independently predicted prognosis. In contrast, cognitive-affective symptoms of depression predicted death/MI in patients younger than 70 years (hazard ratio = 1.03, 95{\%} confidence interval = 1.01–1.04, p = .011), after adjustment for disease severity and comorbidities. Somatic symptoms largely explained the link between cognitive-affective symptoms and adverse events, with the exception of hopelessness (hazard ratio = 1.47, 95{\%} confidence interval = 1.11–1.95, p = .007), suggesting that somatic depressive symptoms accurately reflect the depressed mood state in this age group.Conclusions: Somatic symptoms and hopelessness independently predicted death/MI in MI patients younger than 70 years. Research needs to reexamine the modulating effect of age in studies on somatic and cognitive-affective symptoms of post-MI depression.",
author = "J. Denollet and K.E. Freedland and R.M. Carney and {de Jonge}, P. and A.M. Roest",
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Cognitive-affective symptoms of depression after myocardial infarction : Different prognostic importance across age groups. / Denollet, J.; Freedland, K.E.; Carney, R.M.; de Jonge, P.; Roest, A.M.

In: Psychosomatic Medicine, Vol. 75, No. 7, 2013, p. 701-708.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Cognitive-affective symptoms of depression after myocardial infarction

T2 - Different prognostic importance across age groups

AU - Denollet, J.

AU - Freedland, K.E.

AU - Carney, R.M.

AU - de Jonge, P.

AU - Roest, A.M.

PY - 2013

Y1 - 2013

N2 - Objective: Cognitive-affective symptoms of depression may not be as strongly related to prognosis after myocardial infarction (MI) as somatic depressive symptoms. Because it is not known whether this pattern of results is influenced by the age at which patients are diagnosed as having MI, we examined whether the importance of these symptoms is age dependent in the Enhancing Recovery in Coronary Heart Disease study.Methods: Patients with depression after MI (n = 1823) in the Enhancing Recovery in Coronary Heart Disease study were stratified into the following age groups: younger than 70 years (mean [standard deviation] = 55 [9.0] years) and 70 years or older (mean [standard deviation] = 76 [4.9] years). Measurements included demographic and clinical data and the Beck Depression Inventory. The end point was a composite of recurrent MI and mortality during a mean follow-up of 2.1 years.Results: Patients 70 years or older had more severe manifestations of cardiac disease and somatic comorbidities than did patients younger than 70 years (p < .001). During follow-up, 456 patients died or had a recurrent MI. In patients 70 years or older, increasing age, disease severity, and comorbidities—but not depressive symptoms—independently predicted prognosis. In contrast, cognitive-affective symptoms of depression predicted death/MI in patients younger than 70 years (hazard ratio = 1.03, 95% confidence interval = 1.01–1.04, p = .011), after adjustment for disease severity and comorbidities. Somatic symptoms largely explained the link between cognitive-affective symptoms and adverse events, with the exception of hopelessness (hazard ratio = 1.47, 95% confidence interval = 1.11–1.95, p = .007), suggesting that somatic depressive symptoms accurately reflect the depressed mood state in this age group.Conclusions: Somatic symptoms and hopelessness independently predicted death/MI in MI patients younger than 70 years. Research needs to reexamine the modulating effect of age in studies on somatic and cognitive-affective symptoms of post-MI depression.

AB - Objective: Cognitive-affective symptoms of depression may not be as strongly related to prognosis after myocardial infarction (MI) as somatic depressive symptoms. Because it is not known whether this pattern of results is influenced by the age at which patients are diagnosed as having MI, we examined whether the importance of these symptoms is age dependent in the Enhancing Recovery in Coronary Heart Disease study.Methods: Patients with depression after MI (n = 1823) in the Enhancing Recovery in Coronary Heart Disease study were stratified into the following age groups: younger than 70 years (mean [standard deviation] = 55 [9.0] years) and 70 years or older (mean [standard deviation] = 76 [4.9] years). Measurements included demographic and clinical data and the Beck Depression Inventory. The end point was a composite of recurrent MI and mortality during a mean follow-up of 2.1 years.Results: Patients 70 years or older had more severe manifestations of cardiac disease and somatic comorbidities than did patients younger than 70 years (p < .001). During follow-up, 456 patients died or had a recurrent MI. In patients 70 years or older, increasing age, disease severity, and comorbidities—but not depressive symptoms—independently predicted prognosis. In contrast, cognitive-affective symptoms of depression predicted death/MI in patients younger than 70 years (hazard ratio = 1.03, 95% confidence interval = 1.01–1.04, p = .011), after adjustment for disease severity and comorbidities. Somatic symptoms largely explained the link between cognitive-affective symptoms and adverse events, with the exception of hopelessness (hazard ratio = 1.47, 95% confidence interval = 1.11–1.95, p = .007), suggesting that somatic depressive symptoms accurately reflect the depressed mood state in this age group.Conclusions: Somatic symptoms and hopelessness independently predicted death/MI in MI patients younger than 70 years. Research needs to reexamine the modulating effect of age in studies on somatic and cognitive-affective symptoms of post-MI depression.

U2 - 10.1097/psy.0b013e31829dbd36

DO - 10.1097/psy.0b013e31829dbd36

M3 - Article

VL - 75

SP - 701

EP - 708

JO - Psychosomatic Medicine

JF - Psychosomatic Medicine

SN - 0033-3174

IS - 7

ER -