The impact of depression and sex on the long-term prognosis of patients with coronary artery disease recruited for a psychosocial intervention

OBJECTIVE: Depression is a known risk factor for mortality in CAD patients, though evidence from long-term follow-ups is limited and mixed. This secondary analysis examined whether depression, its severity, and sex interactions predict all-cause mortality in CAD patients over an extended follow-up. METHODS: We analysed 180 CAD patients (mean age 60.6 ± 9.2 years, 26 % women) from three trials involving randomized controlled psychosocial interventions. Depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Mortality data were collected from a community registry and medical records. Patients were compared as depressed (DP, HADS-D ≥ 8) vs. non-depressed (NDP, HADS-D < 8), and severely depressed (SDP, HADS-D ≥ 12) vs. not-to-moderately (NMDP, HADS-D < 12). Kaplan-Meier log-rank tests and Cox regression models, adjusted for age and left ventricular ejection fraction (LVEF), were used to assess survival. Interaction with sex was tested accordingly. RESULTS: Mortality data were available for 175 patients (96.7 %) after a mean follow-up of 13.6 ± 2.1 years. Unadjusted comparisons showed significantly higher mortality in NDP (log-rank p = .031), but in the adjusted model only age (HR:1.08, p < .001) and LVEF (HR:0.96, p < .001) predicted mortality. SDP showed better survival than NMDP in adjusted analyses (HR:0.30, p = .048). Sex and its interaction with depression were not significant overall, but non-depressed men showed higher mortality than depressed men (log-rank p = .010). CONCLUSION: In this long-term analysis, severely depressed CAD patients had better survival prognosis than less depressed or non-depressed patients, possibly due to behavioural changes linked to cardiovascular outcomes. These findings are preliminary and warrant further investigation.