Authors' objectives:

In this report, we examined the evidence addressing the following questions: 1) In patients with acute MI, what is the prevalence of depression during the initial hospitalization? 2) What percentage of patients with post-MI depression continue to have depression one or more months after initial hospital discharge? 3) What is the association of post-MI depression with outcomes or with surrogate markers of cardiac risk, independent of other predictors of post-MI outcomes? 4) Do post-MI patients with depression have better outcomes with depression treatment compared to those without depression treatment? 5) What are the performance characteristics (e.g., sensitivity, specificity, reliability and predictive value) of instruments or methods that are used to screen for depression following an acute MI? 6) Does the use of cardiac treatment for patients with acute MI differ for those with and without depression?

Authors' results and conclusions: The search identified 86 articles with original data that addressed the questions. Results were as follows: 1) The evidence indicated that the prevalence of major depression is about 20 percent in patients hospitalized for MI and that of potentially significant symptoms of depression an additional 10 to 47 percent. 2) Few studies reported the prevalence of depression in patients at the time of the hospitalization and then re-assessed those same patients at follow-up, but the studies indicated that most patients with depression during the initial MI hospitalization remain depressed 1 to 4 months later. 3) Post-MI depression is associated with a significantly increased risk of subsequent death, and of cardiac re-admission and poor quality of life during the first year. There is limited evidence that post-MI depression is associated with surrogate markers of cardiac risk. 4) In post-MI patients with depression, psychosocial intervention improves depression but not other outcomes. In post-MI patients with depression, selective serotonin re-uptake inhibitors (SSRIs) improve depression and some surrogate markers of cardiac risk, but no studies of sufficient power address the question of whether this treatment improves survival. 5) There is insufficient data to adequately assess the performance characteristics of instruments or methods used to screen for depression during the initial MI hospitalization, but most commonly used screening instruments or rating scales have adequate sensitivities and specificities when used within 3 months after initial hospitalization. 6) Patients with post-MI depression exhibit lower adherence to prescribed medications and secondary prevention measures compared to those without depression. The literature was too limited or heterogeneous to make conclusions about whether there are significant differences in cardiac medication prescription or cardiac procedure use in post-MI patients based on the presence or absence of depression.

Authors' recommendations: Evidence is consistent that in patients with MI, depression is common at the time of the hospitalization and persists for at least several months after hospital discharge without treatment. Post-MI depression is associated with a significantly increased risk of subsequent death, and of cardiac re-admission and poor quality of life during the first year. Strong evidence exists to indicate that both psychosocial interventions and SSRIs are effective in improving depression in MI survivors, but there is no evidence that either decreases mortality or cardiac events. Although it is not clear whether the frequency of prescription of cardiac medications or use of cardiac procedures is different based on the presence of depression, there is relatively strong evidence that those with post-MI depression have lower adherence to prescribed medications and secondary prevention measures than those without depression.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/mideptp.htm

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)