The Four Psychological Symptoms Which Can Make Myocardial Infarction Worse
A group of Dutch investigators has identified 4 psychological symptoms which can be associated with increased risk of depression after myocardial infarction, as reported in the November issue of Psychotherapy and Psychosomatics, where the Authors suggests that screening for depression in myocardial infarction (MI) patients must be improved: (1) depression often goes unrecognized and (2) anxiety has been largely overlooked as an essential feature of depression in these patients.
They therefore examined the co-occurrence of anxiety and depression after MI, and the validity of a brief mixed anxiety-depression index as a simple way to identify post-MI patients at increased risk of comorbid depression. One month after MI, 176 patients underwent a psychiatric interview and completed the Beck Depression Inventory (BDI) and the Symptoms of Anxiety-Depression index (SAD4) containing four symptoms of anxiety (tension, restlessness) and depression (feeling blue, hopelessness).
Thirty-one MI patients (18%) had comorbid depression and 37 (21%) depressive or anxiety disorder. High factor loadings and item-total correlations (SAD4, = 0.86) confirmed that symptoms of anxiety and depression co-occurred after MI.
Mixed anxiety-depression (SAD43) was present in 90% of depressed MI patients and in 100% of severely depressed patients. After adjustment for standard depression symptoms (BDI; OR = 4.4, 95% CI 1.6-12.1, p = 0.004), left ventricular ejection fraction, age and sex, mixed anxiety-depression symptomatology was associated with an increased risk of depressive comorbidity (OR = 11.2, 95% CI 3.0-42.5, p
Anxiety is underrecognized in post-MI patients; however, the present findings suggest that anxiety symptomatology should not be overlooked in these patients. Depressive comorbidity after MI is characterized by symptoms of mixed anxiety-depression, after controlling for standard depression symptoms. The SAD4 represents an easy way to recognize the increased risk of post-MI depression.
Johan Denollet, PhD | alfa
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