Abstract 2673: Trajectories and Predictors of Depression Following Acute Myocardial Infarction
Depression after acute myocardial infarction (AMI) may be a reasonable response to real or foreshadowed loss. Depression trajectories, however, may vary from person to person. This study was designed to determine whether there were two or more distinct groups of patients with different trajectories during the first 12 months following AMI and to investigate whether there were significant demographic, physical, psychological, social or behavioral differences between groups.
Methods: Of a consecutive series of 224 men admitted to a single coronary care unit, 188 completed the Beck Depression Inventory (BDI) at three weeks, 177 at four months and 173 at 12 months following AMI and responded to comprehensive interviews and questionnaires.
Results: Using growth mixture modeling, a two-group model provided the best fit of the data. A large group (n=173, 88%) of patients had a mean three-week BDI score of 4.77. This group continued to improve over time with mean BDI score dropping to 4.56 and 3.85 at 4 and 12 months, respectively. The other group of patients (n=23, 12%) had a mean BDI score of 11.51 at three weeks, which rose to 12.97 at four months and to 16.35 at 12 months. There were no significant demographic or physical differences between groups, including no differences in AMI severity. However, during admission to hospital, the group with higher BDI scores had significantly higher levels (p < .05) of state and trait anxiety, other measures of anxiety, neuroticism, financial stress, work stress, occupational maladjustment, marital maladjustment, loneliness and smoking.
Conclusions: There appear to be two distinct identifiable groups of patient trajectories for depression after AMI. The larger group follows a path commonly found with bereavement or an adjustment response. The smaller group has more severe depressive symptoms which worsen over time. This latter group has multiple markers of prior anxiety, life stressors and maladjustments that may represent chronic psychological characteristics. For these few, an AMI or similar episode might overwhelm them, producing a lasting state of clinical depression.