Association of suicidal ideation with depression 1 year after an acute coronary syndrome episode and

Patientswith acute coronary syndrome (ACS) have an increased risk of suicidal behavior [1]. The longitudinal effects of suicidal behaviors are typically studied in depressive patients [2] and predict the relapse and persistence of depression [3]. This issue has not been investigated in ACS patients. The spectrum of suicidal behavior ranges from suicidal ideation (SI) to completion; clinical ACS studies typically utilize SI as a phenotype. Thus, this study examined the effect of SI, evaluated within 2 weeks of an ACS episode, on depressive outcomes at 1-year. We hypothesized that SI during the acute ACS phase would predict depression during the chronic ACS phase. Study data were drawn from a larger investigation, the Korean depression in ACS (K-DEPACS) study. Here, 1152 ACS patients (829 with myocardial infarction, 323 with unstable angina) were assessed in a hospital setting at baseline, within 2 weeks (mean: 6.3 ± 2.4 d) of the ACS episode, and 828were reexamined 1 year later in an outpatient setting; the 324 patients lost to follow-up had significantly older ages and higher Killip classes than those who remained (p b 0.05). SI at baseline was identified by study nurses, who was trained and supervised by the study psychiatrists, using the ‘suicidal thoughts’ item of the Montgomery–Åsberg Depression Rating Scale (MADRS-ST) [4]. SI was diagnosed if the MADRS-ST score was ≥2 (fleeting suicidal thoughts), as in previous studies [5]. Depressive disorders were diagnosed at baseline and follow-up by study psychiatrists using the MINI, a structured diagnostic psychiatric interview for the DSM-IV [6]. At baseline, 446 patients were diagnosed with depressive disorder, whereas 706 were not. At follow-up, depressive disorders were present in 66 of 504 patients (12%) without a depressive disorder at baseline and in 150 of 324 patients (46%) with a depressive disorder at baseline. Patients with depressive disorder at baseline who agreed to participate in a randomized controlled trial received either escitalopram or a placebo, whereas those who did not agree were treated with usual medical care. Patients without depressive disorder at baseline were treated with usual medical care. Severity of depression was assessed with the Beck Depression Inventory (BDI) [7] and the Hamilton Depression Rating Scale (HAMD) [8] at baseline and follow-up. Total scores, excluding the SI items (Item9 for the BDI and Item3 for HAMD),were used for this study. Baseline covariates, including sociodemographic data (age, gender, education, living alone, housing, and employment), depression characteristics, cardiovascular risk factors, and current cardiac status, were compared between patients with and without SI using either t-tests or χ tests. The associations of baseline SI with depressive disorders at follow-up were evaluated with a logistic regression analysis after adjusting for covariates significantly associated with SI at baseline (p b 0.05) and/or treatment status (Model 1) and with all baseline covariates (Model 2). Additionally, these associations were evaluated using a repeated-measures analysis of covariance with changes in BDI