The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up

Psychosom Med. Jul/Aug 2019;81(6):513-520. doi: 10.1097/PSY.0000000000000702.


Objective: Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified and whether they were differentially associated with mortality.

Methods: Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventory - version 1A [BDI-1A]), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni- and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables.

Results: Clinically significant depression was a significant predictor of mortality (hazard ratio = 2.088; 95% confidence interval = 1.366-3.192; p = .001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (hazard ratio = 1.982; 95% confidence interval = 1.220-3.217; p = .006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, whereas neither of the two subscales was an independent predictor of mortality in the multivariate analysis.

Conclusions: Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.

MeSH terms

  • Adult
  • Aged
  • Cardiomyopathies / surgery
  • Cardiovascular Diseases / mortality
  • Cause of Death
  • Depression / epidemiology*
  • Depression / psychology
  • Depressive Disorder / epidemiology*
  • Depressive Disorder / psychology
  • Female
  • Heart Failure / surgery
  • Heart Transplantation*
  • Humans
  • Infections / mortality
  • Male
  • Middle Aged
  • Mortality*
  • Multivariate Analysis
  • Neoplasms / mortality
  • Norway / epidemiology
  • Principal Component Analysis
  • Proportional Hazards Models