Mild Depression Predictive of All-Cause Mortality After MI

Heart attack, conceptual computer illustration.
Patients with depressive symptoms, however mild, face increased mortality risk long after an acute myocardial infarction.

Mild depression was a long-term independent predictor of death in patients after acute myocardial infarction (AMI), per cohort study data published in Heart, Lung and Circulation.

Investigators conducted a 25-year follow-up of men who were recruited after AMI to participate in a randomized controlled trial in the 1980s. The initial trial investigated the impact of high intensity exercise on physical and psychological health; depression was assessed at baseline using the Beck Depression Inventory. Sociodemographic information, cardiovascular risk factors, and severity of AMI were also captured at baseline. During the 25-year follow-up period, investigators used the Australian National Death Index to determine mortality status of patients after their index AMI. Cox proportional-hazards modeling was used to assess the relationship between depression severity and all-cause mortality at 5, 10, 15, 20, and 25 years post-AMI.

The final analysis cohort comprised 185 men, mean age 54.15 (8.54). Per the Beck Depression Inventory, 114 patients (60.4%) had low to no depression, 47 (25.2%) had mild depression, and 27 (14.3%) had moderate to severe depression at baseline. After adjusting for severity of MI and age, a significant relationship between depression and death was observed: patients with mild depression had a higher percentage of death than patients with low or no depression at 5- (P =.001) and 10- (P =.004) year follow-up. The same trend was observed at 15-year follow-up, although it was suggestive rather than statistically significant (P =.006). No association was observed between depression and all-cause mortality at 20 and 25 years. Patients with mild depression had a poorer prognosis than patients with low or moderate to severe depression. The mean survival time in patients with mild depression was 10.18 (9.29) years compared with 15.21 (7.97) years in patients with low to no depression and 11.59 (10.05) years in patients with moderate to severe depression.

These data describe a strong prognostic role for depression in the 15 years following an incident AMI. Clinicians may find these results useful for identifying which patients may be at risk for adverse events following an AMI. Further research is necessary to understand the dose-response relationship between depression severity and risk for all-cause mortality following an MI.


Worcester MU, Goble AJ, Elliott PC, et al. Mild depression predicts long-term mortality after acute myocardial infarction: a 25-year follow-up [published online December 5, 2018]. Heart Lung Circ. doi:10.1016/j.hlc.2018.11.013


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This article originally appeared on Psychiatry Advisor