DOI: 10.1097/01.psy.0000146795.38162.b1
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PMID: 15564342
Issn Print: 0033-3174
Publication Date: 2004/11/01
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Excerpt
The other path has examined whether depression is a risk factor for cardiovascular morbidity and mortality in the context of established CHD. Most of these studies have been based on much smaller samples drawn from single clinical sites. Some of them have had too few cases and/or too few cardiac events for an adequate test of the hypothesis. For example, one study reported an adjusted odds ratio of 4.9 for mortality in patients with moderate to severe depression, but the result was not statistically significant (5). Although this study had a relatively large sample (560 patients), it had only 12 deaths.
Two independent meta-analyses of studies of depression as a risk factor for incident CHD were published approximately 2 years ago. Rugulies (6) identified 11 studies of depression or depressed mood in initially healthy subjects as predictors of MI or cardiac death. His meta-analysis yielded an aggregate relative risk of 1.64 (95% confidence interval, 1.29–2.08). Wulsin and Singal (7) used slightly different inclusion criteria. They identified 10 studies and also reported an aggregate relative risk of 1.64 (confidence interval, 1.41–1.90).
Two independent meta-analyses are also presented in this issue of Psychosomatic Medicine (8,9). Unlike their predecessors, both examine depression as a predictor of mortality in patients with established CHD. Like their predecessors, the analyses have slightly different inclusion criteria. The criteria for the analysis by Barth et al. (8) were relatively broad in the sense that studies of patients at various stages of CHD were included. They report an odds ratio of 2.24 (1.37–3.60) for mortality in patients with symptoms of depression compared with patients without depression symptoms. Van Melle et al. (9), in contrast, limited their analysis to studies of post-MI patients. They reported odds ratios for all-cause and for cardiac-related mortality of 2.38 (1.76–3.22) and 2.59 (1.77–3.77), respectively. The report by Van Melle et al. (9) is also limited to unadjusted analyses. Barth et al. (8) examined both unadjusted and adjusted analyses but found little difference between them with respect to the risk of mortality.
Having been involved in one of the earliest (10) and in one of the most recent (11) of the studies included in these meta-analyses, we are pleased that both meta-analyses support the conclusion that depression is indeed a risk factor for cardiac and all-cause mortality in patients with established CHD. Rigorous meta-analysis is a difficult and time-consuming endeavor, and we commend the authors of both articles for their efforts. Both groups have done an admirable job of identifying the relevant studies and carefully considering their strengths and limitations when choosing which to include in their analyses.
These meta-analyses are also very timely in light of several recent reports that have failed to find relationships between depression and cardiac mortality in post-MI patients, even in univariate analyses. Mayou et al. (12), for example, reported a nonsignificant 1.6 relative risk of mortality. This study had a small sample size and relied on the Hospital Anxiety and Depression Scale rather than an instrument that has more reliably demonstrated prognostic value in patients with CHD.
