What predicts depression in cardiac patients: Sociodemographic factors, disease severity or theoretical vulnerabilities?
Depression is associated with increased cardiovascular risk in acute coronary syndrome (ACS) patients, but some argue that elevated depression is actually a marker of cardiovascular disease severity. Therefore, disease indices should better predict depression than established theoretical
causes of depression (interpersonal life events, reinforcing events, cognitive distortions, type D personality). However, little theory-based research has been conducted in this area. In a cross-sectional design, ACS patients (n = 336) completed questionnaires assessing
depression and psychosocial vulnerabilities. Nested logistic regression assessed the relative contribution of demographic or vulnerability factors, or disease indices or vulnerabilities to depression. In multivariate analysis, all vulnerabilities were independent significant predictors of
depression (scoring above threshold on any scale, 48%). Demographic variables accounted for <1% of the variance of depression status, with vulnerabilities accounting for significantly more (pseudo R
2 = 0.16, χ
2(change) = 150.9,
df = 4, p < 0.001). Disease indices accounted for 7% of the variance in depression (pseudo R
2 = 0.07, χ
2 = 137.9, p < 0.001). However, adding the vulnerabilities
increased the overall variance explained to 22% (pseudo R
2 = 0.22, χ
2 = 58.6, df = 4, p < 0.001). Theoretical vulnerabilities predicted depression status better than did either demographic
or disease indices. The presence of these proximal causes of depression suggests that depression in ACS patients is not simply a result of cardiovascular disease severity.
Keywords: acute coronary syndrome; depression; just world beliefs; life events; personality; psychological theory
Document Type: Research Article
Affiliations: 1: Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland 2: Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
Publication date: 01 May 2011
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