Building a theoretical model of depressive vulnerabilities, depression trajectories and poor outcomes in ACS patients

Abstract

Background: Depression is associated with increased mortality in patients with acute coronary syndrome (ACS). However, little is known about the theoretical causes of depression trajectories post-ACS, and whether these trajectories predict mortality. We tested a theoretical model of depressive vulnerabilities, trajectories and mortality. Methods: A prospective observational study of 374 ACS patients was conducted. Participants completed questionnaires on vulnerabilities (interpersonal life events, reinforcing events, cognitive distortions, Type D personality) during hospitalisation and depression at baseline and 3-, 6- and 12-months post-hospitalisation. Latent class analysis determined trajectories of depression. A generalised structural equation model tested relationships among vulnerabilities, depression trajectories and 7-year mortality. Results: Four depression trajectory categories were found: persistent (15%); subthreshold (37%); never depressed (48%). Vulnerabilities independently predicted trajectories, with effect sizes significantly highest for persistent depression. Both subthreshold and persistent depression trajectories were significant predictors of mortality (e.g. persistent depression OR=2.4, 95% CI=1.8-3.1), relative to never depressed. Conclusions: Theoretical vulnerabilities measured during hospitalisation can identify those at risk for persistent depression and elevated mortality risk post-ACS.