Depression Risk High in Women Under 60 With MI

Women younger than age 60 have “a remarkably higher rate of depression at the time of acute myocardial infarction, compared with the other demographic groups,” reported Dr. Susmita Mallik of Emory University, Atlanta, and her associates.

The researchers found that 40% of women aged 60 or younger had moderate or worse clinical depression in the multicenter PREMIER study, which enrolled nearly 2,500 MI patients.

“Even after adjusting for various demographic, behavioral, medical history, and clinical factors,” their odds of depression were significantly higher than for other groups and remained over three times higher than those for the reference group, which was men older than 60 years.

It seems likely that this high rate of depression may explain, at least in part, the higher rate of adverse outcomes after MI that has been noted in women, compared with men. Depression predicts higher mortality in MI, with a clear dose-response relationship between severity of depressive symptoms and mortality risk. Depression also is linked to longer hospitalization and worse symptomatic, psychological, and social outcomes.

To date, no study has evaluated the potential role that depression may play in this MI gender gap, Dr. Mallik and her associates noted (Arch. Intern. Med. 2006;166:876–83).

The PREMIER (Prospective Registry Evaluating Outcomes after Myocardial Infarction: Events and Recovery) study recruited 2,498 MI patients treated at 19 U.S. medical centers during 2003–2004. Participants were interviewed at admission for MI on sociodemographic, behavioral, and psychosocial factors as well as clinical factors.

Depressive symptoms at presentation were assessed using the nine-question Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire. Possible scores range from 0 to 27, and a score of 10 or higher indicates major depression of a moderate or worse degree.

Major depression was common, with an overall rate of 22%. Younger age, African American race, unmarried status, low levels of social support, and unfavorable socioeconomic indicators all positively correlated with depression.

Women under 60 years had the highest prevalence of depression, 40%, and the highest depression scores, indicating that they experienced more depressive symptoms as well as more severe symptoms than did men and older patients. After the data were adjusted for numerous potentially confounding factors, the odds of depression for women under 60 remained 3.1 times higher than those for the reference group of men over 60.

The cause remains unknown because the study was not designed to examine possible causes. Similarly, the researchers could not determine whether the depressive symptoms were secondary to MI or began shortly before its onset.

Nevertheless, “clinicians should be aware that younger women have a high susceptibility for being depressed after acute MI. Although screening for depression is warranted in all acute MI patients, screening should be particularly aggressive in younger female patients with acute MI,” the researchers stressed.

“Depression was largely unrecognized and untreated in our study,” Dr. Mallik and her associates noted.

Of the depressed patients, 73% had no history of depression when they presented with MI, which suggests the disorder was either unrecognized or that it developed for the first time in association with MI.

Notably, only 18% of the depressed patients were discharged with prescriptions for antidepressants. Clinicians should be reminded that “depression in patients with MI remains a serious condition and deserves treatment,” the researchers said.

“In addition to being an important illness in its own right, depression during hospitalization with acute MI confers 3–5 times higher adjusted odds of death” within 6 months, they added.

Women younger than age 60 have “a remarkably higher rate of depression at the time of acute myocardial infarction, compared with the other demographic groups,” reported Dr. Susmita Mallik of Emory University, Atlanta, and her associates.

The researchers found that 40% of women aged 60 or younger had moderate or worse clinical depression in the multicenter PREMIER study, which enrolled nearly 2,500 MI patients.

“Even after adjusting for various demographic, behavioral, medical history, and clinical factors,” their odds of depression were significantly higher than for other groups and remained over three times higher than those for the reference group, which was men older than 60 years.

It seems likely that this high rate of depression may explain, at least in part, the higher rate of adverse outcomes after MI that has been noted in women, compared with men. Depression predicts higher mortality in MI, with a clear dose-response relationship between severity of depressive symptoms and mortality risk. Depression also is linked to longer hospitalization and worse symptomatic, psychological, and social outcomes.

To date, no study has evaluated the potential role that depression may play in this MI gender gap, Dr. Mallik and her associates noted (Arch. Intern. Med. 2006;166:876–83).

The PREMIER (Prospective Registry Evaluating Outcomes after Myocardial Infarction: Events and Recovery) study recruited 2,498 MI patients treated at 19 U.S. medical centers during 2003–2004. Participants were interviewed at admission for MI on sociodemographic, behavioral, and psychosocial factors as well as clinical factors.

Depressive symptoms at presentation were assessed using the nine-question Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire. Possible scores range from 0 to 27, and a score of 10 or higher indicates major depression of a moderate or worse degree.

Major depression was common, with an overall rate of 22%. Younger age, African American race, unmarried status, low levels of social support, and unfavorable socioeconomic indicators all positively correlated with depression.

Women under 60 years had the highest prevalence of depression, 40%, and the highest depression scores, indicating that they experienced more depressive symptoms as well as more severe symptoms than did men and older patients. After the data were adjusted for numerous potentially confounding factors, the odds of depression for women under 60 remained 3.1 times higher than those for the reference group of men over 60.

The cause remains unknown because the study was not designed to examine possible causes. Similarly, the researchers could not determine whether the depressive symptoms were secondary to MI or began shortly before its onset.

Nevertheless, “clinicians should be aware that younger women have a high susceptibility for being depressed after acute MI. Although screening for depression is warranted in all acute MI patients, screening should be particularly aggressive in younger female patients with acute MI,” the researchers stressed.

“Depression was largely unrecognized and untreated in our study,” Dr. Mallik and her associates noted.

Of the depressed patients, 73% had no history of depression when they presented with MI, which suggests the disorder was either unrecognized or that it developed for the first time in association with MI.

Notably, only 18% of the depressed patients were discharged with prescriptions for antidepressants. Clinicians should be reminded that “depression in patients with MI remains a serious condition and deserves treatment,” the researchers said.

“In addition to being an important illness in its own right, depression during hospitalization with acute MI confers 3–5 times higher adjusted odds of death” within 6 months, they added.

Women younger than age 60 have “a remarkably higher rate of depression at the time of acute myocardial infarction, compared with the other demographic groups,” reported Dr. Susmita Mallik of Emory University, Atlanta, and her associates.

The researchers found that 40% of women aged 60 or younger had moderate or worse clinical depression in the multicenter PREMIER study, which enrolled nearly 2,500 MI patients.

“Even after adjusting for various demographic, behavioral, medical history, and clinical factors,” their odds of depression were significantly higher than for other groups and remained over three times higher than those for the reference group, which was men older than 60 years.

It seems likely that this high rate of depression may explain, at least in part, the higher rate of adverse outcomes after MI that has been noted in women, compared with men. Depression predicts higher mortality in MI, with a clear dose-response relationship between severity of depressive symptoms and mortality risk. Depression also is linked to longer hospitalization and worse symptomatic, psychological, and social outcomes.

To date, no study has evaluated the potential role that depression may play in this MI gender gap, Dr. Mallik and her associates noted (Arch. Intern. Med. 2006;166:876–83).

The PREMIER (Prospective Registry Evaluating Outcomes after Myocardial Infarction: Events and Recovery) study recruited 2,498 MI patients treated at 19 U.S. medical centers during 2003–2004. Participants were interviewed at admission for MI on sociodemographic, behavioral, and psychosocial factors as well as clinical factors.

Depressive symptoms at presentation were assessed using the nine-question Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire. Possible scores range from 0 to 27, and a score of 10 or higher indicates major depression of a moderate or worse degree.

Major depression was common, with an overall rate of 22%. Younger age, African American race, unmarried status, low levels of social support, and unfavorable socioeconomic indicators all positively correlated with depression.

Women under 60 years had the highest prevalence of depression, 40%, and the highest depression scores, indicating that they experienced more depressive symptoms as well as more severe symptoms than did men and older patients. After the data were adjusted for numerous potentially confounding factors, the odds of depression for women under 60 remained 3.1 times higher than those for the reference group of men over 60.

The cause remains unknown because the study was not designed to examine possible causes. Similarly, the researchers could not determine whether the depressive symptoms were secondary to MI or began shortly before its onset.

Nevertheless, “clinicians should be aware that younger women have a high susceptibility for being depressed after acute MI. Although screening for depression is warranted in all acute MI patients, screening should be particularly aggressive in younger female patients with acute MI,” the researchers stressed.

“Depression was largely unrecognized and untreated in our study,” Dr. Mallik and her associates noted.

Of the depressed patients, 73% had no history of depression when they presented with MI, which suggests the disorder was either unrecognized or that it developed for the first time in association with MI.

Notably, only 18% of the depressed patients were discharged with prescriptions for antidepressants. Clinicians should be reminded that “depression in patients with MI remains a serious condition and deserves treatment,” the researchers said.

“In addition to being an important illness in its own right, depression during hospitalization with acute MI confers 3–5 times higher adjusted odds of death” within 6 months, they added.