Even minimal symptoms of depression increase mortality risk after acute myocardial infarction

Mild to moderate levels of depressive symptoms as characterized by Beck Depression Inventory (BDI) scores of greater than or equal to 10 are associated with decreased survival after acute myocardial infarction (AMI). We investigated whether lower levels of depressive symptoms are also associated with increased mortality risk after AMI. We prospectively studied 285 patients with AMI who survived to discharge for evidence, at the time of hospitalization, Of a DSM-IIIR mood disorder (using a structured clinical interview) and for symptoms of depression (using the BDI). The overall mortality rate at 4 months was 6.7%. Multiple logistic regression (chi-square 35.79, p less than or equal to 0.001) revealed that the independent predictors of mortality were: age greater than or equal to 65 years, left ventricular ejection fraction < 35%, diabetes mellitus, and any depression (DSM-IIIR mood disorder or BDI : 10) present at the time of AML Among patients :65 years old with left ventricular ejection fraction < 35%, the 4-month mortality was 12%. However, in this some group, those with any depression at the time of AMI had a 4-month mortality of 50% (relative risk 4.1, p = 0.01). Among patients aged :65 years, the mortality according to BDI scale grouping 0 to 3, 4 to 9, and 10+ was 2.6%, 17.1%, and 23.3%, respectively (p < 0.002). Highest mortality rates were observed in patients with most severe depressive symptoms. However, compared with those without depression, higher mortality was also observed at very low levels of depressive symptoms (BDI 4 to 9) not generally considered clinically significant and below the level usually considered predictive of increased post-AMI mortality. (C) 2001 by Excerpta Medica, Inc.