Cognitive depressive symptoms were associated with depression recognition (RR 1.14; 95% CI 1.03-1.26), whereas somatic symptoms were associated with 1-year rehospitalization (HR 1.16; 95% CI 1.06-1.27).
Cohort (n=2,828)
Yes
Are cognitive and somatic depressive symptoms differentially associated with depression recognition and long-term outcomes in patients after acute myocardial infarction?
In post-AMI patients, cognitive depressive symptoms drive clinical recognition of depression, whereas somatic symptoms are more strongly associated with adverse clinical outcomes like rehospitalization.
Relative Risk: 1.14 (95% CI 1.03–1.26)
p-value: p=0.01
BACKGROUND: Among patients with acute myocardial infarction (AMI), depression is both common and underrecognized. The association of different manifestations of depression, somatic and cognitive, with depression recognition and long-term prognosis is poorly understood. METHODS AND RESULTS: Depression was confirmed in 481 AMI patients enrolled from 21 sites during their index hospitalization with a Patient Health Questionnaire (PHQ-9) score > or =10. Within the PHQ-9, separate somatic and cognitive symptom scores were derived, and the independent association between these domains and the clinical recognition of depression, as documented in the medical records, was evaluated. In a separate multisite AMI registry of 2347 patients, the association between somatic and cognitive depressive symptoms and 4-year all-cause mortality and 1-year all-cause rehospitalization was evaluated. Depression was clinically recognized in 29% (n=140) of patients. Cognitive depressive symptoms (relative risk per SD increase, 1.14; 95% CI, 1.03 to 1.26; P=0.01) were independently associated with depression recognition, whereas the association for somatic symptoms and recognition (relative risk, 1.04; 95% CI, 0.87 to 1.26; P=0.66) was not significant. However, unadjusted Cox regression analyses found that only somatic depressive symptoms were associated with 4-year mortality (hazard ratio HR per SD increase, 1.22; 95% CI, 1.08 to 1.39) or 1-year rehospitalization (HR, 1.22; 95% CI, 1.11 to 1.33), whereas cognitive manifestations were not (HR for mortality, 1.01; 95% CI, 0.89 to 1.14; HR for rehospitalization, 1.01; 95% CI, 0.93 to 1.11). After multivariable adjustment, the association between somatic symptoms and rehospitalization persisted (HR, 1.16; 95% CI, 1.06 to 1.27; P=0.01) but was attenuated for mortality (HR, 1.07; 95% CI, 0.94 to 1.21; P=0.30). CONCLUSIONS: Depression after AMI was recognized in fewer than 1 in 3 patients. Although cognitive symptoms were associated with recognition of depression, somatic symptoms were associated with long-term outcomes. Comprehensive screening and treatment of both somatic and cognitive symptoms may be necessary to optimize depression recognition and treatment in AMI patients.
Smolderen et al. (2009) conducted a cohort in Acute myocardial infarction and depression (n=2,828). Cognitive and somatic depressive symptoms vs. Lower symptom scores was evaluated on Clinical recognition of depression (RR 1.14, 95% CI 1.03-1.26, p=0.01). Cognitive depressive symptoms were associated with depression recognition (RR 1.14; 95% CI 1.03-1.26), whereas somatic symptoms were associated with 1-year rehospitalization (HR 1.16; 95% CI 1.06-1.27).