Depression is sometimes described as a feeling of "heart breaking" sadness. Emory scientists presented research here today at the American Heart Association's (AHA) Scientific Sessions which suggests this may be literally true -- especially for younger women who have suffered heart attacks.
"We found that the prevalence of depression is high in younger women with myocardial infarction (MI). This is particularly important because depression after MI has been associated with adverse outcomes," says Emory Heart Center scientist Viola Vaccarino, MD, PhD, senior author of the study. "That means younger female patients may represent an important target group for screening and treatment of post-MI depression."
Susmita Mallik, MD, of the Emory Department of Medicine, lead author of the study, worked with Dr. Vaccarino, Emory Heart Center cardiologists Nannette K. Wenger, MD and William S. Weintraub, MD , and Harlan M. Krumholz, MD of Yale University, John S. Rumsfeld, MD of the Denver V.A. Medical Center and John A. Spertus, MD of the Mid-America Heart Institute in Kansas City on the research, which was presented at an AHA session entitled "Heartbroken: Uncovering the Link Between Depression and Heart Disease."
A total of 2,219 patients (712 women and 1,507 men) meeting clinical criteria of acute MI were enrolled from 19 US centers for the PREMIER (Prospective Registry Evaluating Outcomes after Myocardial Infarction: Events and Recovery) study. To find out how many of these research subjects had depressive symptoms, the researchers used the Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire (PHQ) for depression assessment.
The result? "We knew that younger women are at risk for depression so we hypothesized younger women with MI would have higher rates of depression than the other groups," says Dr. Vaccarino. "But we were surprised that the rate of depression was so much greater than for other groups."
The younger patients (those under 60, who comprised a little less than half the research group) had higher PHQ scores than older patients and women had higher depression scores than men. Younger women had the highest PHQ scores of all.
"The prevalence of depression was 41 percent in women younger than 60 compared to 21 percent in women over 60. We found depression in 21 percent of the younger men and in only 16 percent of the men over 60," notes Dr. Vaccarino. "When we adjusted for race, coronary heart disease (CHD) history, other health conditions, alcohol use, smoking and blood pressure, the odds of depression for women younger than sixty were almost four times higher than in men over 60."
Dr. Vaccarino adds that while it is not clear why younger women with MI have more depression, there are several possibilities. Sex hormones and/or dysregulation of the stress hormone system in women who have been exposed to early trauma could play a role. "In addition, gender roles might predispose women to psychosocial stressors such as poverty and low education. Inequities at work and at home -- which could be particularly hard on a woman who has just had a heart attack -- could be a factor," says Dr. Vaccarino. "Also, women may be more prone than men to recall or to admit mood symptoms such as sadness, although this would not explain why younger women would be more likely to report these symptoms than older women."
The Emory research team points out that it is important for physicians to understand the importance of depression following heart attack. "Not all patients develop depression after MI, and depression should not be considered a normal reaction to the MI. Doctors may be so busy addressing the medical problems of the heart attack that they may not pay much attention to the patient's mood. However, depression is such a strong risk factor for outcomes after MI, that assessment for depressive symptoms should not be neglected," concludes Dr. Vaccarino.