Prevalence of depression in survivors of acute myocardial infarction

Abstract

Objectives: To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence.

Data sources: MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE.

Review methods: A comprehensive search was conducted in March 2004 to identify original research studies published since 1980 that used a standardized interview or validated questionnaire to assess depression. The search was augmented by hand searching of selected journals from October 2003 through April 2004 and references of identified articles and reviews. Studies were excluded if only an abstract was provided, if not in English, or if depression was not measured by a validated method.

Results: Major depression was identified in 19.8% (95% confidence interval [CI] 19.1% to 20.6%) of patients using structured interviews (N=10,785, 8 studies). The prevalence of significant depressive symptoms based on a Beck Depression Inventory score > or =10 was 31.1% (CI 29.2% to 33.0%; N=2,273, 6 studies), using a Hospital Anxiety and Depression Scale (HADS) score > or =8%, 15.5% (CI 13.2% to 18.0%; N=863, 4 studies), and with a HADS score > or =11%, 7.3% (CI 5.5% to 9.3%; N=830, 4 studies). Although a significant proportion of patients continued to be depressed in the year after discharge, the limited number of studies and variable follow-up times precluded specification of prevalence rates at given time points.

Conclusions: Depression is common and persistent in AMI survivors. Prevalence varies depending on assessment method, likely reflecting treatment of somatic symptoms.

FIGURE 1

Prevalence of depression during hospitalization for acute myocardial infarction. The reported prevalence of depression in included studies is depicted, along with the error bars indicating 95% confidence intervals. Shown in forward crosshatched bars are the prevalence rates in studies that used structured interviews (top group). Shown in backward crosshatched bars are the prevalence rates using a Beck Depression Inventory score of 10 or greater (second group from top). Shown in black dots on a white background are the prevalence rates using a Hospital Anxiety and Depression Scale (HADS) score of 8 or greater (second group from bottom). Shown in vertical bars are prevalence rates using a HADS score of 11 or greater (bottom group). Weighted group prevalence rates are shown in solid black bars beneath each group.