Symptom and course heterogeneity of depressive symptoms and prognosis following myocardial infarction

Health Psychol. 2016 May;35(5):413-22. doi: 10.1037/hea0000256. Epub 2015 Sep 21.


Objective: Previously published findings from the DepreMI cohort suggested that both the course and the type of depressive symptoms following myocardial infarction (MI) are related to prognosis but did not examine both factors simultaneously. The aim of this reanalysis study was to assess whether MI patients can be empirically classified based on trajectories of cognitive/affective (CA) and somatic/affective (SA) symptoms, and whether these classes differentially predict adverse outcomes.

Method: Patients with acute MI (n = 457) were recruited between 1997 and 2000 and provided (BDI-I) data at baseline, 3, 6 and 12 months. Parallel Processes latent class growth analysis was used to identify latent classes. Patients were followed up until 2007 for all-cause mortality and cardiovascular readmissions.

Results: Three classes were identified: low severity = consistently low CA and SA (n = 316); somatic persistence = consistently low CA and high SA (n = 110); and overall persistence = high and increasing CA and SA (n = 31). After adjustment for gender and the Global Registry of Acute Coronary Events risk score, somatic persistence (hazard ratio [HR]: 1.86; 95% CI: 1.18-2.94; p = .008) but not overall persistence (HR: 1.09.; 95% CI: 0.39-3.03; p = .87), predicted mortality compared with low severity. Classes were not predictive of nonfatal cardiovascular events.

Conclusions: MI patient classes differed in severity and course of CA and SA depressive symptoms in the post-MI year. Only a class with persistent SA depressive symptoms was associated with increased mortality compared with patients with low severity. This is suggestive of different origins of SA depressive symptoms in MI patients that may explain the differential associations with mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Depression / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / psychology*
  • Odds Ratio
  • Prognosis
  • Retrospective Studies
  • Risk