Prevalence and Persistence of Depression Following Myocardial Infarction

Depressive symptoms and major depression have been consistently reported as common psychological reactions to MI. Major depression, a syndrome characterized by persistently depressed mood, and/or loss of interest and pleasure, with symptoms lasting for a minimum of 2 weeks, occurs with an annual prevalence of between 1% and 6% in the general population, with rates typically higher among patients following MI, at approximately 16-18%.12 Apart from major depression, depressive symptoms are quite prevalent among the general population, with rates ranging from 10% to 29%. Earlier studies of MI patients reported levels of depressive symptoms varying markedly, from 18% to 60%, although the majority of more recent studies report relatively consistent prevalence rates ranging from 17% to 37%.12

Little is known about the persistence of depression after an acute MI since few studies have repeatedly measured depression in the months following the event. However, it would appear that depressive symptoms first emerge between 48 and 72 hours following MI.12,13 In the majority of post-MI patients, symptoms of depression are reported to abate after 5 or 6 days.14 However, in some patients distress persists for several months after discharge, with some patients only becoming depressed after discharge from hospital, in the first few months following the infarction.

The majority of the more recent studies of MI patients have limited the formal assessment of symptoms of depression to the period prior to discharge from hospital. However, there are at least two compelling reasons why the assessment of depression should be continued beyond discharge. First,there is the proposed prognostic significance of post-MI depression. Some, although by no means all studies, have found that depressive symptomatology following MI increases the risk of death and/or recurrent cardiac events (see Table 32-1). Second, depression also significantly impairs quality of life and reduces the likelihood of participation in cardiac rehabilitation. Third, it is necessary to establish whether symptoms of depression experienced in hospital are associated with cardiac disease severity or are largely a reaction to hospitalization per se.

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