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Emotional triggering and low socio-economic status as determinants of depression following acute coronary syndrome

Published online by Cambridge University Press:  07 January 2011

A. Steptoe ,
G. J. Molloy ,
N. Messerly-Bürgy ,
A. Wikman ,
G. Randall ,
L. Perkins-Porras  and
J. C. Kaski
A. Steptoe*
Affiliation:
Department of Epidemiology and Public Health, University College London, London, UK
G. J. Molloy
Affiliation:
Department of Psychology, University of Stirling, Stirling, UK
N. Messerly-Bürgy
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
A. Wikman
Affiliation:
Department of Epidemiology and Public Health, University College London, London, UK
G. Randall
Affiliation:
Department of Epidemiology and Public Health, University College London, London, UK
L. Perkins-Porras
Affiliation:
Division of Community Health Sciences, St. George's, University of London, London, UK
J. C. Kaski
Affiliation:
Division of Cardiac and Vascular Sciences, St. George's, University of London, London, UK
*
*Address for correspondence: Dr A. Steptoe, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK. (Email: a.steptoe@ucl.ac.uk)
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Abstract

Background

The determinants of depression following acute coronary syndrome (ACS) are poorly understood. Triggering of ACS by emotional stress and low socio-economic status (SES) are predictors of adverse outcomes. We therefore investigated whether emotional triggering and low SES predict depression and anxiety following ACS.

Method

This prospective observational clinical cohort study involved 298 patients with clinically verified ACS. Emotional stress was assessed for the 2 h before symptom onset and compared with the equivalent period 24 h earlier using case-crossover methods. SES was defined by household income and education. Depression was measured with the Beck Depression Inventory and the Hamilton Rating Scale for Depression and anxiety with the Hospital Anxiety and Depression Scale 3 weeks after ACS and again at 6 and 12 months. Age, gender, ethnicity, marital status, the Global Registry of Acute Coronary Events risk score, duration of hospital stay and history of depression were included as covariates.

Results

Emotional stress during the 2-h hazard period was associated with increased risk of ACS (odds ratio 1.88, 95% confidence interval 1.01–3.61). Both low income and emotional triggering predicted depression and anxiety at 3 weeks and 6/12 months independently of covariates. The two factors interacted, with the greatest depression and anxiety in lower income patients who experienced acute emotional stress. Education was not related to depression.

Conclusions

Patients who experience acute emotional stress during their ACS and are lower SES as defined by current affluence and access to resources are particularly vulnerable to subsequent depression and anxiety.

Keywords

Acute coronary syndromeanxietydepressionemotional triggeringphysical exertionsocio-economic status
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 9 , September 2011 , pp. 1857 - 1866
Copyright
Copyright © Cambridge University Press 2011

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