Key result
CABG surgery was associated with an initial increased risk of depression at 1-2 weeks (RR 1.27; 95% CI 1.01-1.61), followed by a significantly decreased risk at >6 months (RR 0.68; 95% CI 0.58-0.79).
Why the study?
Does the risk of depression change after coronary artery bypass graft (CABG) surgery compared to preoperative levels?
Meta-Analysis
Does the risk of depression change after coronary artery bypass graft (CABG) surgery compared to preoperative levels?
Effect estimate: RR 0.68 (95% CI 0.58-0.79)
The risk of depression initially increases 1-2 weeks post-CABG but significantly decreases from 2 weeks to >6 months postoperatively, though many patients do not achieve full remission.
Early post-CABG depression monitoring is warranted with later risk reduction expected; extends meta-analytic evidence on temporal mental health trajectories.
LEARNING OBJECTIVES: After participating in this educational activity, the reader should be better able to measure the risk of depression before and after coronary artery bypass graft (CABG) surgery; examine the course of depression after CABG; and apply the results of the study to the treatment of patients. OBJECTIVE: Depression is highly comorbid with coronary artery disease. Clinicians face the question of whether patients' depressive symptoms will improve after coronary artery bypass graft surgery (CABG). The objective of this meta-analysis is to determine the course of depressive symptoms after CABG. METHODS: EMBASE, PubMed, and PsycINFO were searched for studies assessing depression before and after CABG. Meta-analyses were performed for depression at early (1-2 weeks), recovery (>2 weeks to 2 months), mid (>2 months to 6 months), and late (>6 months) postoperative time points. Heterogeneity and publication bias were analyzed. RESULTS: Thirty-nine studies were included in the meta-analysis. Twelve reported dichotomous outcomes; 18 reported continuous outcomes; and 9 reported both. Risk of depression was increased early (relative risk [RR] = 1.27; 95% confidence interval [CI], 1.01-1.61). There was a significantly decreased risk of depression at recovery (RR = 0.78; 95% CI, 0.67-0.90), mid (RR = 0.64; 95% CI, 0.58-0.70), and late (RR = 0.68; 95% CI, 0.58-0.79) time points without heterogeneity. All studies reporting continuous depression scales had significant heterogeneity. CONCLUSIONS: The risk of depression decreased post-CABG when depression was measured dichotomously. While depression improves overall and remits for some patients after CABG, the majority of patients will not experience remission of depression. Preoperative and postoperative depression monitoring is important.
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Ravven et al. (2013) conducted a meta-analysis in Depression and coronary artery disease. Coronary artery bypass graft (CABG) surgery vs. Preoperative baseline was evaluated on Risk of depression at late (>6 months) postoperative time point (RR 0.68, 95% CI 0.58-0.79). CABG surgery was associated with an initial increased risk of depression at 1-2 weeks (RR 1.27; 95% CI 1.01-1.61), followed by a significantly decreased risk at >6 months (RR 0.68; 95% CI 0.58-0.79).