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Circulation. 2002;105:1049-1053
Published online before print February 4, 2002, doi: 10.1161/hc0902.104707
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(Circulation. 2002;105:1049.)
© 2002 American Heart Association, Inc.


Clinical Investigation and Reports

Five-Year Risk of Cardiac Mortality in Relation to Initial Severity and One-Year Changes in Depression Symptoms After Myocardial Infarction

François Lespérance, MD; Nancy Frasure-Smith, PhD; Mario Talajic, MD; Martial G. Bourassa, MD

From the Departments of Psychiatry (F.L., N.F.S.), University of Montreal and McGill University; the Research Centers, Montreal Heart Institute (F.L., N.F.S., M.T., M.G.B.) and Centre Hospitalier de l’Université de Montréal (F.L., N.F.S.); and Department of Medicine (M.T., M.G.B.), University of Montreal, Canada.

Correspondence to François Lespérance, MD, Research Center, Montreal Heart Institute, 5000 Belanger St E, Montreal, Quebec H1T 1C8, Canada. E-mail francois.lesperance{at}umontreal.ca

Background Although previous research demonstrated an independent link between depression symptoms and cardiac mortality after myocardial infarction (MI), depression was assessed only once, and a dose-response relationship was not evaluated.

Methods and Results We administered the Beck Depression Inventory to 896 post-MI patients during admission and at 1 year. Five-year survival was ascertained using Medicare data. We observed a significant long-term dose-response relationship between depression symptoms during hospitalization and cardiac mortality. Results remained significant after control for multiple measures of cardiac disease severity. Although 1-year scores were also linked to cardiac mortality, most of that impact was explained by baseline scores. Improvement in depression symptoms was associated with less cardiac mortality only for patients with mild depression. Patients with higher initial scores had worse long-term prognosis regardless of symptom changes.

Conclusions The level of depression symptoms during admission for MI is more closely linked to long-term survival than the level at 1 year, particularly in patients with moderate to severe levels of depression, suggesting that the presumed cardiovascular mechanisms linking depression to cardiac mortality may be more or less permanent for them.


Key Words: myocardial infarction • depression • prognosis




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M. J. Zellweger, R. H. Osterwalder, W. Langewitz, and M. E. Pfisterer
Coronary artery disease and depression
Eur. Heart J., January 1, 2004; 25(1): 3 - 9.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
H. Luukinen, P. Laippala, and H.V. Huikuri
Depressive symptoms and the risk of sudden cardiac death among the elderly
Eur. Heart J., November 2, 2003; 24(22): 2021 - 2026.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
R. A.H. Stewart, F. M. North, T. M. West, K. J. Sharples, R.J. Simes, D. M. Colquhoun, H. D. White, A. M. Tonkin, and for the Long-Term Intervention With Pravastatin in
Depression and cardiovascular morbidity and mortality: cause or consequence?
Eur. Heart J., November 2, 2003; 24(22): 2027 - 2037.
[Abstract] [Full Text] [PDF]


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J Am Psychiatr Nurses AssocHome page
N. Cuellar, S. Cochran, C. Ladner, B. Mercier, A. Townsend, B. Harbaugh, and D. Douglas
Depression and the Use of Conventional and Nonconventional Interventions by Rural Patients
Journal of the American Psychiatric Nurses Association, October 1, 2003; 9(5): 151 - 158.
[Abstract] [PDF]


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QJMHome page
A. Schattner
The emotional dimension and the biological paradigm of illness: time for a change
QJM, September 1, 2003; 96(9): 617 - 621.
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CirculationHome page
V. L. Serebruany, A. H. Glassman, A. I. Malinin, C. B. Nemeroff, D. L. Musselman, L. T. van Zyl, M. S. Finkel, K. R. R. Krishnan, M. Gaffney, W. Harrison, et al.
Platelet/Endothelial Biomarkers in Depressed Patients Treated With the Selective Serotonin Reuptake Inhibitor Sertraline After Acute Coronary Events: The Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy
Circulation, August 26, 2003; 108(8): 939 - 944.
[Abstract] [Full Text] [PDF]


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Psychosom. Med.Home page
E. C. Suarez
Joint Effect of Hostility and Severity of Depressive Symptoms on Plasma Interleukin-6 Concentration
Psychosom Med, July 1, 2003; 65(4): 523 - 527.
[Abstract] [Full Text] [PDF]


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JAMAHome page
Writing Committee for the ENRICHD Investigators
Effects of Treating Depression and Low Perceived Social Support on Clinical Events After Myocardial Infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial
JAMA, June 18, 2003; 289(23): 3106 - 3116.
[Abstract] [Full Text] [PDF]


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Arch Gen PsychiatryHome page
N. Frasure-Smith and F. Lesperance
Depression and Other Psychological Risks Following Myocardial Infarction
Arch Gen Psychiatry, June 1, 2003; 60(6): 627 - 636.
[Abstract] [Full Text] [PDF]


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CMAJHome page
F. Lesperance and N. Frasure-Smith
Depression and coronary artery disease: time to move from observation to trials
Can. Med. Assoc. J., March 4, 2003; 168(5): 570 - 571.
[Full Text] [PDF]


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HeartHome page
P C Strike and A Steptoe
Depression, stress, and the heart
Heart, December 1, 2002; 88(5): 441 - 443.
[Full Text] [PDF]


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Int J EpidemiolHome page
D. Lane, D. Carroll, C. Ring, D G. Beevers, and G. Y H Lip
In-hospital symptoms of depression do not predict mortality 3 years after myocardial infarction
Int. J. Epidemiol., December 1, 2002; 31(6): 1179 - 1182.
[Abstract] [Full Text] [PDF]


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Psychosom. Med.Home page
N. Frasure-Smith, F. Lesperance, G. Gravel, A. Masson, M. Juneau, and M. G. Bourassa
Long-Term Survival Differences Among Low-Anxious, High-Anxious and Repressive Copers Enrolled in the Montreal Heart Attack Readjustment Trial
Psychosom Med, July 1, 2002; 64(4): 571 - 579.
[Abstract] [Full Text] [PDF]