Most physicians know to screen those who survive a heart attack for
symptoms of depression because the psychiatric disorder can contribute to
further cardiac trouble. However, new research indicates that younger women
may benefit most from such screening, because they are the most vulnerable to
depression following a heart attack.
The two-and-a-half-year study of 2,498 survivors of myocardial infarction
found that the prevalence of depression is highest in women younger than age
60. The study chose a cut-off point of 60 years because it was the median age
in their study population. The highest percentage of patients with depression,
however, was found in women aged 45 to 49.
The study, "Depression Symptoms After Acute Myocardial
Infarction," was published in the April Archives of Internal
"Clinicians should be aware that women were more likely to show signs
of depression after myocardial infarction than were men," said Susmita
Mallik, M.D., lead author of the study and an assistant professor of medicine
at Emory University School of Medicine. "They should also be aware that
depressed heart attack patients are more likely to have worse health status
and die [sooner], compared with patients who are not depressed."
The study stemmed from the finding in previous research that women who had
heart attacks had higher mortality rates, and these rates were not based on
medical history, clinical severity, or treatments. Earlier studies had
discovered that women had depression rates up to twice those of men after
heart attacks, but the impact of age was unknown.
The authors were spurred to further drill down among heart attack patients
in the light of other research that identified younger women among those most
susceptible to depression in the general population.
The findings suggested that screenings for depression should be"
particularly aggressive" among younger women hospitalized for
heart attacks, Mallik said. Depression during hospitalization for acute
myocardial infarction confers three to five times higher adjusted odds of
death within six months, according to previous research.
Mallick's study assessed subjects for depression during hospitalization for
myocardial infarction and classified them as depressed if they scored at least
10 on the Primary Care Evaluation of Mental Disorders Brief Patient Health
Questionnaire (PHQ). The study found that younger people had higher mean PHQ
scores than older patients (6.4 vs. 5.0), and younger women had the highest
PHQ scores (8.2).
Forty percent of women who had suffered a heart attack at age 60 or younger
had depression, Mallick found, and 21 percent of women older than 60 had
depression. In contrast, only 22 percent of men aged 60 or younger had
depression. Women 60 or younger were three times more likely to have
depression after a heart attack than were men over 60.
Only about 27 percent of depressed patients in the study had a history of
depression prior to the heart attack.
The study does not formally recommend any treatment for such patients
because trials of depression treatments after heart attack have not identified
clear advantages for a particular approach. Randomized future trials are
needed, Mallik said, to show whether treating depression improves health
outcomes after a heart attack.
"At the same time, depression is an important illness in its own
right, and it is important to treat it regardless of other conditions,"
The reasons for the higher rates of depression among younger women who have
had heart attacks remain unclear. The researchers hypothesized that younger
women are more predisposed to stressors, such as poverty, low education
levels, responsibilities at home and work, and taking care of both children
and aging parents.
Others theorize that estrogen cyclicity and metabolic syndrome may be a
factor in predisposing younger women to depression, but the researchers
stressed that they do not know for certain.
Mallik also was recently awarded an American Heart Association grant to
follow up on the study's findings. She plans to use the grant to compare the
effects of depression on prognosis after heart attack between women and men.
Mallik hypothesizes that depression is a stronger predictor of adverse
outcomes in women following heart attacks and may explain the higher risk of
adverse outcomes in women.