Depression Treatment and Health Status Outcomes in Young Patients With Acute Myocardial Infarction
Authors: Kim G. Smolderen, John A. Spertus, Kensey Gosch, Rachel P. Dreyer, Gail D’Onofrio, Judith H. Lichtman, Mary Geda, John Beltrame, Basmah Safdar, Héctor Bueno, Harlan M. Krumholz
Journal: Circulation (2017)

Depression is common among patients with acute myocardial infarction (AMI) and associated with adverse outcomes.Because depression disproportionately affects women, we examined sex differences in depression treatment rates in young patients with depressive symptoms following AMI admission and evaluated 1-year depressive symptom and health status outcomes by sex and depression treatment status.We evaluated these by using the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), a multicenter, international, prospective cohort study that enrolled patients aged 18 to 55 years (66.8% women). 1 VIRGO was approved by Yale's Institutional Review Board and all patients in the study provided informed consent.We abstracted medical records and conducted in-person interviews to record patient characteristics and used the 9-item Patient Health Questionnaire (PHQ-9) 2 to assess depressive symptoms during or shortly after the AMI admission and 1 and 12 months later.Depression treatment was assessed among those with baseline PHQ-9 scores ≥10.Receiving depression treatment was defined as new or continued antidepressant medications or depression counseling at discharge or within at 1 month of discharge.To compare outcomes as a function of depression treatment, we quantified outcomes in those with (1) no significant depressive symptoms (baseline PHQ-9<10);(2) treated depressive symptoms (baseline PHQ-9≥10 and receiving treatment); (3) untreated transient depressive symptoms (baseline PHQ-9≥10 and untreated, but PHQ-9<10 at 1 month); (4) untreated persistent depressive symptoms (baseline PHQ-9≥10 and untreated, and PHQ remained ≥10 at 1 month).The clinical logic for further categorizing untreated depressive symptoms into transient and persistent was to describe the greater benefit of treating those with sustained depressive symptoms rather than transient, self-resolving symptoms.Disease-specific and generic Health Status outcomes were quantified with the Seattle Angina Questionnaire and the EQ-5D visual analogue scale, respectively, up to 1 year. 3,4 Depression treatment rates were calculated and compared by sex using χ 2 tests.The independent association between sex and lack of depression treatment was evaluated among those who had PHQ-9 scores ≥10 at baseline by using a hierarchical logistic regression model with a random effect for site and adjusting for age, race, marital status, education, insurance status, prior peripheral arterial disease, diabetes mellitus, prior AMI, prior percutaneous coronary intervention, prior coronary artery bypass grafting, current smoking, ST-segment-elevation myocardial infarction, ejection fraction, heart failure, renal disease, chronic lung disease, cancer, body mass index, PHQ-9 baseline score, and somatic versus cognitive depressive symptoms.One-year health status change scores were compared by the 4 depression treatment groups (analysis of variance and Wilcoxon tests).