Psychological Medicine

Original Articles

Cardiac history, prior depression and personality predict course of depressive symptoms after myocardial infarction

E. J. Martensa1 c1, O. R. F. Smitha1, J. Wintera2, J. Denolleta1 and S. S. Pedersena1

a1 CoRPS – Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands

a2 Department of Cardiology, TweeSteden Hospital Tilburg, The Netherlands


Background Although many studies have focused on post-myocardial infarction (MI) depression, there is limited information about the evolution and determinants of depressive symptoms in the first year post-MI. Therefore we examined (1) the course of depressive symptoms during the first year post-MI and (2) the predictors of these symptom trajectories.

Method To assess depressive symptoms, 287 patients completed the Beck Depression Inventory during hospitalization for MI, and 2, and 12 months post-MI. Personality was assessed with the Type-D scale during hospitalization. We used latent class analysis to examine the evolution of depressive symptoms over a 1-year period and multinomial logit regression analyses to examine predictors of these symptom trajectories.

Results The course of depressive symptoms was stable during the first year post-MI. Four groups were identified and classified as non-depressed [40%, intercept (IC) 2.52], mildly depressed (42%, IC 6.91), moderately depressed (14%, IC 13.73) or severely depressed (4%, IC 24.54). In multivariate analysis, cardiac history (log ORsevere 2.93, p=0.02; log ORmoderate 1.81, p=0.02; log ORmild 1.46, p=0.01), history of depression (log ORsevere 4.40, p<0.001; log ORmoderate 1.97, p=0.03) and Type-D personality (log ORsevere 4.22, p<0.001; log ORmoderate=4.17, p<0.001; log ORmild 1.66, p=0.02) were the most prominent risk factors for persistence of depressive symptoms during the first year post-MI.

Conclusions Symptoms of depression tend to persist during the first year post-MI. Cardiac history, prior depression and Type-D personality were identified as independent risk factors for persistence of depressive symptoms. The results of this study strongly argue for routine psychological screening during hospitalization for acute MI in order to identify patients who are at risk for chronicity of depressive symptoms and its deleterious effects on prognosis.

(Received January 02 2007)

(Revised June 15 2007)

(Accepted June 22 2007)

(Online publication September 17 2007)


c1 Address for correspondence: E. J. Martens, Ph.D., CoRPS, Department of Medical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. (Email:


This work was presented at the European Conference on Psychosomatic Research, 27 September 2006, Dubrovnik, Croatia.