Background: Depression after acute coronary syndrome (ACS) is associated with worse cardiac outcomes. This systematic review evaluated whether depressed ACS patients are at differential risk depending on the recurrence and timing of onset of depressive episodes. Methods: MEDLINE, EMBASE and PsycINFO were searched from inception to 11 April 2009. Additionally, reference lists and recent tables of contents of 34 selected journals were manually searched. Eligible studies evaluated cardiovascular outcomes for subgroups of ACS patients with depression or depressive symptoms according to recurrence or onset. Results: Six studies were included that reported outcomes for subgroups of ACS patients with first-ever versus recurrent depression. Four of these reported also outcomes for post-ACS onset versus pre-ACS onset depression, and incident versus nonincident depression. Worse outcomes (odds ratio >1.4) were reported for ACS patients with first-ever depression in 3 of 6 studies (1 study p < 0.05), for patients with post-ACS onset depression in 3 of 4 studies (1 study p < 0.05, but better outcomes in one study) and for patients with incident depression in 2 of 4 studies (no studies p < 0.05). Conclusions: Although it is still suggested that ACS patients with first and new-onset depression are at particularly increased risk of worse prognosis, the inconsistent results from the studies included in this systematic review show that there is no consistent evidence to support such statements.

1.
Van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, van Veldhuisen DJ, van den Brink RH, van den Berg MP: Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 2004;66:814–822.
2.
Carney RM, Freedland KE, Steinmeyer B, Blumenthal JA, Berkman LF, Watkins LL, Czajkowski SM, Burg MM, Jaffe AS: Depression and five-year survival following acute myocardial infarction: a prospective study. J Affect Disord 2008;109:133–138.
3.
De Jonge P, Ormel J, van den Brink RH, van Melle JP, Spijkerman TA, Kuijper A, van Veldhuisen DJ, van den Berg MP, Honig A, Crijns HJ, Schene AH: Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. Am J Psychiatry 2006;163:138–144.
4.
Hoen PW, Conradi HJ, Denollet J, Martens EJ, de Jonge P: Interview-based ratings of somatic and cognitive symptoms of depression and their impact on cardiovascular prognosis. Psychother Psychosom 2010;79:319–320.
5.
Kaptein KI, de Jonge P, van den Brink RH, Korf J: Course of depressive symptoms after myocardial infarction and cardiac prognosis: a latent class analysis. Psychosom Med 2006;68:662–668.
6.
Carney RM, Blumenthal JA, Freedland KE, Youngblood M, Veith RC, Burg MM, Cornell C, Saab PG, Kaufmann PG, Czajkowski SM, Jaffe AS: Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study. Psychosom Med 2004;66:466–474.
7.
Lesperance F, Frasure-Smith N, Talajic M: Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med 1996;58:99–110.
8.
Grace SL, Abbey SE, Kapral MK, Fang J, Nolan RP, Stewart DE: Effect of depression on five-year mortality after an acute coronary syndrome. Am J Cardiol 2005;96:1179–1185.
9.
De Jonge P, van den Brink RH, Spijkerman TA, Ormel J: Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events. J Am Coll Cardiol 2006;48:2204–2208.
10.
Dickens C, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed F: New onset depression following myocardial infarction predicts cardiac mortality. Psychosom Med 2008;70:450–455.
11.
De Jonge P, Ormel J: Heterogeneity of patients with coronary artery disease and distress and the need to identify relevant subtypes. Arch Gen Psychiatry 2008;65:851–852.
12.
Glassman AH, O’Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger JT Jr, Krishnan KR, van Zyl LT, Swenson JR, Finkel MS, Landau C, Shapiro PA, Pepine CJ, Mardekian J, Harrison WM, Barton D, Mclvor M: Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002;288:701–709.
13.
Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, Czajkowski SM, DeBusk R, Hosking J, Jaffe A, Kaufmann PG, Mitchell P, Norman J, Powell LH, Raczynski JM, Schneiderman N: 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 2003;289:3106–3116.
14.
Van Melle JP, de Jonge P, Honig A, Schene AH, Kuyper AM, Crijns HJ, Schins A, Tulner D, van den Berg MP, Ormel J: Effects of antidepressant treatment following myocardial infarction. Br J Psychiatry 2007;190:460–466.
15.
Lesperance F, Frasure-Smith N, Koszycki D, Laliberte MA, van Zyl LT, Baker B, Swenson JR, Ghatavi K, Abramson BL, Dorian P, Guertin MC: Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA 2007;297:367–379.
16.
Kraemer HC, Morgan GA, Leech NL, Gliner JA, Vaske JJ, Harmon RJ: Measures of clinical significance. J Am Acad Child Adolesc Psychiatry 2003;42:1524–1529.
17.
Harrell FE Jr, Lee KL, Mark DB: Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996;15:361–387.
18.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373–1379.
19.
Babyak MA: What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med 2004;66:411–421.
20.
Altman DG: Systematic reviews of evaluations of prognostic variables. BMJ 2001;323:224–228.
21.
Parker GB, Hilton TM, Walsh WF, Owen CA, Heruc GA, Olley A, Brotchie H, Hadzi-Pavlovic D: Timing is everything: the onset of depression and acute coronary syndrome outcome. Biol Psychiatry 2008;64:660–666.
22.
Carney RM, Freedland KE, Steinmeyer B, Blumenthal JA, de Jonge P, Davidson KW, Czajkowski SM, Jaffe AS: History of depression and survival after acute myocardial infarction. Psychosom Med 2009;71:253–259.
23.
Glassman AH, Bigger JT Jr, Gaffney M: Psychiatric characteristics associated with long-term mortality among 361 patients having an acute coronary syndrome and major depression: seven-year follow-up of SADHART participants. Arch Gen Psychiatry 2009;66:1022–1029.
24.
Zuidersma M, de Jonge P: The effects of treatment-resistant depression and first-ever depression on mortality following acute coronary syndrome: interactive or independent? Am J Psychiatry 2009;166:828–829.
25.
Glassman AH, Bigger JT, Gaffney M, Shapiro PA, Swenson JR: Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit. Arch Gen Psychiatry 2006;63:283–288.
26.
Spijkerman TA, van den Brink RH, May JF, Winter JB, van Melle JP, de Jonge P, Crijns HJ, Ormel J: Decreased impact of post-myocardial infarction depression on cardiac prognosis? J Psychosom Res 2006;61:493–499.
27.
WHO: Composite International Diagnostic Interview (CIDI). Geneva, WHO, 1990.
28.
Enhancing recovery in coronary heart disease (ENRICHD): baseline characteristics. Am J Cardiol 2001;88:316–322.
29.
Nicholson A, Kuper H, Hemingway H: Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6,362 events among 146,538 participants in 54 observational studies. Eur Heart J 2006;27:2763–2774.
30.
Patten SB: Accumulation of major depressive episodes over time in a prospective study indicates that retrospectively assessed lifetime prevalence estimates are too low. BMC Psychiatry 2009;9:19.
31.
Wise TN: Diagnostic criteria for psychosomatic research are necessary for DSM V. Psychother Psychosom 2009;78:330–332.
32.
Fava GA, Sonino N: Psychosomatic assessment. Psychother Psychosom 2009;78:333–341.
33.
Macleod J, Davey Smith G: Depression as risk factor for mortality after coronary artery bypass surgery. Lancet 2003;362:1500–1501.
34.
Sorensenf C, Friis-Hasche E, Haghfelt T, Bech P: Postmyocardial infarction mortality in relation to depression: a systematic critical review. Psychother Psychosom 2005;74:69–80.
35.
Davey Smith G, Phillips AN: Confounding in epidemiological studies: why ‘independent’ effects may not be all they seem. BMJ 1992;305:757–759.
36.
Blumenthal JA, Lett HS, Babyak MA, White W, Smith PK, Mark DB, Jones R, Mathew JP, Newman MF: Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 2003;362:604–609.
37.
Christenfeld NJ, Sloan RP, Carroll D, Greenland S: Risk factors, confounding, and the illusion of statistical control. Psychosom Med 2004;66:868–875.
38.
Goodman J, Shimbo D, Haas DC, Davidson KW, Rieckmann N: Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients. J Psychiatr Res 2008;42:670–675.
39.
Freedland KE, Carney RM, Lustman PJ, Rich MW, Jaffe AS: Major depression in coronary artery disease patients with vs without a prior history of depression. Psychosom Med 1992;54:416–421.
40.
Linke SE, Rutledge T, Johnson BD, Vaccarino V, Bittner V, Cornell CE, Eteiba W, Sheps DS, Krantz DS, Parashar S, Bairey Merz CN: Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: a report from the National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation. Arch Gen Psychiatry 2009;66:499–507.
41.
Martens EJ, Hoen PW, Mittelhaeuser M, de JP, Denollet J: Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis. Psychol Med 2010;40:807–814.
42.
De Jonge P, Honig A, van Melle JP, Schene AH, Kuyper AM, Tulner D, Schins A, Ormel J: Nonresponse to treatment for depression following myocardial infarction: association with subsequent cardiac events. Am J Psychiatry 2007;164:1371–1378.
43.
Carney RM, Freedland KE: Treatment-resistant depression and mortality after acute coronary syndrome. Am J Psychiatry 2009;166:410–417.
44.
Thombs BD, Ziegelstein RC, Stewart DE, Abbey SE, Parakh K, Grace SL: Usefulness of persistent symptoms of depression to predict physical health status 12 months after an acute coronary syndrome. Am J Cardiol 2008;101:15–19.
45.
Alexopoulos GS, Meyers BS, Young RC, Kakuma T, Silbersweig D, Charlson M: Clinically defined vascular depression. Am J Psychiatry 1997;154:562–565.
46.
Rapp MA, Rieckmann N, Lessman DA, Tang CY, Paulino R, Burg MM, Davidson KW: Persistent depressive symptoms after acute coronary syndrome are associated with compromised white matter integrity in the anterior cingulate: a pilot study. Psychother Psychosom 2010;79:149–155.
47.
Lemogne C, Nabi H, Zins M, Cordier S, Ducimetiere P, Goldberg M, Consoli SM: Hostility may explain the association between depressive mood and mortality: evidence from the French GAZEL cohort study. Psychother Psychosom 2010;79:164–171.
48.
Cockram CA, Doros G, de Figueiredo JM: Diagnosis and measurement of subjective incompetence: the clinical hallmark of demoralization. Psychother Psychosom 2009;78:342–345.
49.
Lichtenberg P, Belmaker RH: Subtyping major depressive disorder. Psychother Psychosom 2010;79:131–135.
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