Depressive symptoms in persons with acute coronary syndrome: Specific symptom scales and prognosis

Objective: To determine which particular depressive symptom scales, derived from three scales, predicted poorer prognosis in persons with acute coronary syndrome (ACS). Methods: Hospitalized ACS patients (n=408) completed questionnaires (depression, vital exhaustion). Mokken scaling derived unidimensional scales. Major cardiac events (cardiac mortality, ACS, unplanned revascularization) were assessed at median 67 weeks post event. Results: Only depressive symptoms of fatigue-sadness predicted prognosis in univariate (hazard ratio [HR]=1.8, 95% CI 1.1-3.0, P=.025) and multivariate analysis (HR=1.8, 95% CI 1.1-2.9, P=.025). Symptoms of anhedonia (HR=1.6, 95% CI 0.9-2.8, P=.102) and depressive cognitions (HR=1.3, 95% CI 0.7-2.2, P=.402) did not. Conclusion: Symptoms of fatigue-sadness, but not other symptoms, were associated with increased risk of major cardiac events. Depression should be considered as a multidimensional, rather than a unidimensional, entity when designing interventions. (C) 2010 Elsevier Inc. All rights reserved.