The presence of a depressive episode predicts lower return to work rate after myocardial infarction

CONTEXT: No studies have evaluated whether the presence of a depressive episode is associated with an increased risk of not returning to work following myocardial infarction (MI). OBJECTIVES: To examine the prospective associations between depressive episode and anxiety disorders with return to work (RTW) after MI at 3 and 12 months based on International Classification of Diseases, 10th Revision. DESIGN: Prospective cohort study. SETTING: Four hospitals in the North of The Netherlands. PARTICIPANTS: From a sample of patients hospitalized for MI (n=487), we selected those who had a paid job at the time of the MI (N=200). MAIN EXPOSURE MEASURES: Presence of a depressive episode and presence of any anxiety disorder during the first 3 months post-MI. MAIN OUTCOME MEASURES: RTW at 12 months post-MI. RESULTS: Of the patients with work prior to MI, 75% had returned to work at 12 months. The presence of a depressive episode during the first 3 months (prevalence: 19.4%) was a significant predictor of no RTW at 12 months post-MI, also after controlling for confounders [odds ratio (OR) 3.48; 95% confidence interval (CI): 1.45-8.37]. The presence of an anxiety disorder (prevalence: 11.9%) had a borderline significant association with no RTW as well. This association remained after controlling for confounders (OR 2.90; 95% CI: 1.00-6.38) but diminished when controlling for depression. CONCLUSIONS: The presence of a depressive episode was associated with an increased risk of no RTW in MI patients. The association between anxiety and risk of no RTW could in part be explained by the presence of depression. Further studies may address the possibility of countering the effect of depression by effective treatment.