April 26, 2009Open Access
View Full PaperThe Association of Cognitive and Somatic Depressive Symptoms With Depression Recognition and Outcomes After Myocardial Infarction
Key Result
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).
Study Design
Type
Cohort (n=2,828)
Multicenter
Yes
Structured PICO
Are cognitive and somatic depressive symptoms differentially associated with depression recognition and long-term outcomes in patients after acute myocardial infarction?
P
Population
481 AMI patients with depression evaluated for clinical recognition, and a separate registry of 2,347 AMI patients evaluated for 4-year mortality and 1-year rehospitalization.
E
Exposure
Cognitive and somatic depressive symptoms (assessed via PHQ-9)
O
Outcome
Clinical recognition of depression (in the 481-patient cohort); 4-year all-cause mortality and 1-year all-cause rehospitalization (in the 2,347-patient cohort)hard clinical
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.
Main Result
Relative Risk: 1.14 (95% CI 1.03–1.26)
p-value: p=0.01
Abstract
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.