Association of depression and coronary heart disease in the participants from the strategy of registry in acute coronary syndrome study (the ERICO study)

Abstract

Introduction: Depression is 3 times more common in patients after acute coronary syndrome (ACS). Further, depressive symptoms and clinical depression have an unfavorable impact on mortality in these patients. The Patient Health Questtionaire-9 (PHQ-9) is a brief depression screening instrument that has been shown reasonable sensitivity and specificity in this group. Objectives: To evaluate the baseline frequency of mild-moderate depressive symptoms, major depression and, their associations to ACS among participants from the ERICO study(Strategy of Registry of Acute Coronary Syndrome). Methods: This is an ancillary study of the ERICO study, an ongoing cohort study held at the University Hospital of the Universityof São Paulo, a teaching public hospital located in São Paulo, Brazil. The ERICO study aims to verify the frequency of ACS and its subtypes, the role of potential risk factors and the long-term event rate. Besides the cardiovascular evaluation, participants are invited to answer PHQ-9 (score range 0 –27 points). The presence of mild to moderate depressive symptoms was defined as a score from 1 to 9 points. Major depression (MD) was defined as a score of 10 or more points. Results: From September 2009 to January 2011, 452 patients ( 35 years) were diagnosed as having SCA. From 218 patients (mean age 62 years) who answered PHQ-9, 130 (59%) were male. 65 (29.8%) were diagnosed as having unstable angina, 94 (43.1%) as non-ST elevation myocardial infaction (MI) and 59 (27.1%) as ST-elevation MI. Almost 90% had at least one depressive symptom and, the most common complaint was “felling tired or having little energy”. Major depression was present in 77 (35.3%) ACS patients. MD was more frequent in women than in men (59.7% vs. 40.3%, p<0.001). Almost 50% of married patients had MD (p=0.02). Other sociodemographics factors had no association with clinical depression. ACS subtypes did no nfluency the frequency of depressive symptoms or MD. Conclusion: Compared to previous studies, we found a higher frequency of MD, regardless of ACS subtypes. Follow-up study will address the impact of depressive symptoms and MD in long-term outcomes.