Key Points
- To evaluate the co-occurrence of anxiety and depression after myocardial infarction and assess whether a four-item mixed anxiety-depression index can identify patients at increased risk for depressive comorbidity.
- Evaluated 176 patients one month following myocardial infarction using a structured psychiatric interview.
- Administered the Beck Depression Inventory (BDI) and the four-item Symptoms of Anxiety-Depression index (SAD(4)), assessing tension, restlessness, feeling blue, and hopelessness.
- Depressive comorbidity was diagnosed in 18% (n=31) of patients and depressive or anxiety disorder in 21% (n=37), with mixed anxiety-depression (SAD(4) ≥ 3) present in 90% of depressed and 100% of severely depressed patients (Cronbach's alpha = 0.86).
- After adjusting for BDI depression scores (OR = 4.4, 95% CI 1.6–12.1, p = 0.004), left ventricular ejection fraction, age, and sex, mixed anxiety-depression remained independently associated with depressive comorbidity (OR = 11.2, 95% CI 3.0–42.5, p < 0.0001) and depressive or anxiety disorder (OR = 9.2, 95% CI 3.0–27.6, p < 0.0001).
Structured PICO
Does the SAD(4) index identify post-MI patients at increased risk of comorbid depression?
PPopulation176 patients assessed one month after myocardial infarction
IInterventionAssessment using the Symptoms of Anxiety-Depression index (SAD(4))
OOutcomePresence of comorbid depression and depressive or anxiety disorderpatient reported
The SAD(4) index is a simple and valid tool to identify post-MI patients at increased risk of comorbid depression and anxiety.