Stability and transitions of depressive subtypes and their association with patient characteristics in patients with coronary heart disease

OBJECTIVE: The aim of this study was to explore the development, persistence, and recovery of depressive symptoms in patients with coronary heart disease (CHD), and how medical and psychosocial factors may influence such transition patterns.

METHODS: 1530 patients (21.3% women, mean age: 64.7±10.1 y) who received a percutaneous coronary intervention (PCI) were included. Stability and transition patterns of depressive subtypes at one month, six months, one year, and two years after PCI were studied using latent transition analysis in MPlus, with nine indicators derived from the PHQ-9 and BDI-II, and characterized using medical, psychosocial, and cardiovascular factors. Methods were pre-registered: osf.io/xay2h/.

RESULTS: A non-depressed (79.9%), depressed (5.7%), and fatigued (14.4%) class were found at one month after PCI. Transition patterns comprised no depressive symptoms (71.6%), chronic fatigue (11.6%), a delayed onset of fatigue/depressive symptoms (6.3%), recovery of symptoms (2.5%), and chronic depression (1.4%). Multiple factors were related to the different patterns, e.g., less cardiac self-efficacy (OR=1.06, 95% CI=1.03-1.08) and more anxiety symptoms (OR=1.35, 95% CI=1.25-1.46) were associated with the chronically fatigued group compared with the stable non-depressed group.

CONCLUSIONS: The majority of patients with CHD do not report chronic depressed or fatigued symptoms. However, a substantial part does, and these symptoms may emerge after regular cardiac rehabilitation is finished.