“The World Health Organization predicts that by 2020 depression will be the second leading cause of disability and mortality in the world, surpassed only by ischaemic heart disease,” said Dr. Pranas Serpytis of Lithuania.
“Major depression follows myocardial infarction (MI) in approximately 18 percent of cases and is an important predictor of disability and poor quality of life in the year post-MI.”
He noted that patients with depression are nearly six times more likely to die within six months after an MI than those without depression.
“The increased risk of death in patients with depression persists up to 18 months after the MI,” he continued. “But despite the fact that post-MI depression is common and burdensome, the condition remains under-recognized and undertreated.”
The current study investigated the impact of gender and cardiovascular disease risk factors on the risk of developing depression and anxiety after an MI. It was presented at the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC) in Geneva, Switzerland.
The study included 160 patients admitted with a myocardial infarction to the Vilnius University Hospital Santariskiu Clinics in Vilnius, Lithuania.
Patients were interviewed at least one month after the MI to collect demographic information, including gender, age, education and marital status; clinical characteristics, such as incidence of diabetes mellitus, previous treatment for hypertension, and previous MI; other cardiovascular disease risk factors, such as smoking and extent of physical activity; and history of mental health issues.
Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS) — no depression and anxiety (0-7 score), possible depression and anxiety (8-10), mild to moderate levels of depression and anxiety symptoms (11+ score).
The researchers found that nearly one quarter of patients in the study were depressed (24.4 percent). Of those, 28.2 percent had received treatment with antidepressants. The average HADS score for depression was 6.87 in men and 8.66 in women. For anxiety, the mean score was 7.18 in men and 8.20 in women.
“We found that women were more likely to develop anxiety and depression after a heart attack than men,” Serpytis said. “More research is needed to discover the possible reasons for this.”
The researchers also found a link between anxiety and smoking. In the study, 15.6 percent of patients were current smokers. Their mean HADS score for anxiety was 10.16. An additional 77.5 percent of patients had never smoked and their mean HADS score for anxiety was 7.3. The 6.9 percent of patients who had quit smoking more than two years ago had a mean HADS score for anxiety of 4.55.
“Current smokers were more likely to have anxiety after an MI than never smokers or people who had quit smoking more than two years ago,” Serpytis said. “We did not find any association between smoking and depression after an MI.”
Physically inactive patients tended to be depressed, with a mean HADS score of 8.96, he noted. Overall, 64 percent of patients with depression said they were not physically active, he added.
“Women are misrepresented in many clinical studies on MI even though they often have worse outcomes,” Serpytis said.
“Our study shows that women are more likely to develop anxiety and depression after MI than men but until now this issue has been largely unnoticed. Clinicians should assess MI patients, particularly women, for anxiety and depression so that timely treatment can be started.”
The study also suggests that patients should be encourage to quit smoking and increase their activity levels, which should reduce their risks of anxiety and depression after MI, he concluded.