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Evidence for Highest Rates in Younger Women

Susmita Mallik, MD, MPH, MS; John A. Spertus, MD, MPH; Kimberly J. Reid, MS; Harlan M. Krumholz, MD, SM; John S. Rumsfeld, MD, PhD; William S. Weintraub, MD; Purva Agarwal, MD; Mugdha Santra, MD; Savita Bidyasar, MD; Judith H. Lichtman, PhD; Nanette K. Wenger, MD; Viola Vaccarino, MD, PhD; for the PREMIER Registry Investigators

Arch Intern Med. 2006;166:876-883.

Background  Depression is common in patients hospitalized with acute myocardial infarction (AMI). In the community, younger women are uniquely prone to depression. Whether younger women are also more likely to have depression during hospitalization with AMI is unknown.

Methods  A total of 2498 AMI patients (1284 patients 60 years; 814 women and 1684 men) were enrolled from 19 US centers in the Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery (PREMIER) study between January 2003 and June 2004. Depression was assessed at the time of hospitalization and was defined as a Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire (PHQ) score of 10 or higher.

Results  Younger (60 years) patients had higher mean PHQ scores than older patients (6.4 vs 5.0; P<.001) and women had higher mean PHQ scores than men (6.8 vs 5.2; P<.001). When stratified by both age and sex, younger women had the highest PHQ scores (8.2; P<.001 for the sex-age interaction). The prevalence of depression was 40% in women 60 years or younger, 21% in women older than 60, 22% in men 60 or younger, and 15% in men older than 60. In a logistic model adjusted for study center, race, medical history, and coronary heart disease risk factors, the odds of depression for women 60 years or younger were significantly higher than for the other sex-age groups and were 3.1 times higher than the reference group of men older than 60 years.

Conclusions  The prevalence of depression is high in younger women with AMI. Because depression after AMI has been associated with adverse outcomes, younger women, a high-risk group compared with men, may particularly benefit from aggressive screening and treatment of post-AMI depression.

Author Affiliations: Department of Medicine, Division of General Medicine (Dr Mallik), and Department of Medicine, Division of Cardiology (Drs Weintraub, Agarwal, Santra, Bidyasar, Wenger, and Vaccarino), Emory University School of Medicine, Atlanta, Ga; Mid America Heart Institute, Kansas City, Mo (Dr Spertus and Ms Reid); Section of Cardiovascular Medicine, Departments of Medicine (Dr Krumholz) and Epidemiology and Public Health (Drs Krumholz and Lichtman), Yale University School of Medicine, New Haven, Conn; and Denver Veterans Affairs Medical Center, Denver, Colo (Dr Rumsfeld).

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