YOUNGER WOMEN APPEAR TO BE AT INCREASED RISK FOR DEPRESSION AFTER HEART ATTACK
06 February 2007 - Emory University

Women age 60 years or younger are more likely than other patients to be depressed during hospitalization for heart attack, according to a study in the Archives of Internal Medicine, one of the JAMA/Archives journals.

Depression is common in patients with cardiovascular disease, including acute myocardial infarction (heart attack), according to background information in the article. Depressed heart attack patients are more likely to be hospitalized and die of heart problems and tend to have worse health and higher health care costs than heart attack patients who are not depressed. Identifying patients who are likely to be depressed after heart attack could help physicians screen and treat those at highest risk.

Susmita Mallik, MD, MPH, Emory University School of Medicine, and colleagues assessed the prevalence of depression in 2,498 patients who were hospitalized with acute myocardial infarction between January 2003 and June 2004 at 19 study sites across the United States. The study was conducted in collaboration with expert researchers Drs. Nanette Wenger and Viola Vaccarino in the Division of Cardiology at Emory University. The 814 women and 1,684 men were interviewed during their hospitalization and asked how often they experienced each of nine symptoms of depression. For each patient, researchers compiled an overall depression score between zero and 27 by adding up points for each answer, from zero for each symptom that bothered the patient "not at all" to three for each that he or she experienced "nearly every day." Individuals with a score of 10 or higher were classified as depressed. Participants' medical records also were thoroughly reviewed.

Patients were interviewed an average of 2.9 days after they arrived at the hospital. About 22 percent of all the participants were depressed, and those who were depressed had more associated illnesses, were in poorer health and were more likely to have a history of heart problems and diabetes than those who were not. Women and younger patients (age 60 years or younger) were more likely to be depressed than men and older patients, with younger women at highest risk. The prevalence of depression was 40 percent in women age 60 years or younger, 21 percent in women older than 60, 22 percent in men 60 or younger and 15 percent in men older than 60. In additional analysis in which other factors were considered, the odds of depression were three times higher for women age 60 years and younger than for men older than age 60 years.

Researchers are not sure why younger women are most likely to be depressed after heart attack, but the authors suggest that hormones and social pressures may contribute to their increased risk. "Differential sex roles and exposure to social and environmental stressors, such as poverty, lower level of education, responsibilities both at work and home, single parenthood and caring for children and aging parents, could theoretically contribute to a higher preponderance of depression in younger women, who may have greater exposure to these stressors compared with other groups," they write.

These findings also suggest that depression may be part of the reason that younger women are more likely than younger men to have complications or die after heart attack, although further study is needed to evaluate this connection. Either way, younger women may benefit from more aggressive screening and treatment of depression after heart attack, the authors conclude. (Arch Intern Med. 2006; 166: 876-883)

This study was supported by the Emory University General Clinical Research Center and by a grant from CV Therapeutics, Palo Alto, Calif.

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