Psychological Medicine

Original Articles

Depressive symptom dimensions and cardiac prognosis following myocardial infarction: results from the ENRICHD clinical trial

S. Bekke-Hansena1 c1, M. Trockela2, M. M. Burga3a4 and C. Barr Taylora2

a1 Department of Psychology, Aarhus University, Aarhus, Denmark

a2 Department of Psychiatry and Behavior Sciences, Stanford University, Stanford, CA, USA

a3 Columbia University Medical Center, New York, NY, USA

a4 Yale University Medical School, New Haven, CT, USA


Background Depression following myocardial infarction (MI) independently increases risk for early cardiac morbidity and mortality. Studies suggest that somatic, but not cognitive, depressive symptoms are responsible for the increased risk. However, the effects of somatic depressive symptoms at follow-up, after sufficient time has elapsed to allow for physical recovery from the initial infarction, are not known. Our aim was to examine the relationship between cognitive and somatic depressive symptom dimensions at baseline and 12 months post-MI and subsequent mortality and cardiovascular morbidity.

Method Patients were 2442 depressed and/or socially isolated men and women with acute MI included in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. We used principal components analysis (PCA) of the Beck Depression Inventory (BDI) items to derive subscales measuring cognitive and somatic depressive symptom dimensions, and Cox regression with Bonferroni correction for multiple testing to examine the contribution of these dimensions to all-cause mortality, cardiovascular mortality, and first recurrent non-fatal MI.

Results After adjusting for medical co-morbidity and Bonferroni correction, the somatic depressive symptom dimension assessed proximately following MI did not significantly predict any endpoints. At 12 months post-MI, however, this dimension independently predicted subsequent all-cause [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.13–1.81] and cardiovascular mortality (HR 1.60, 95% CI 1.17–2.18). No significant associations were found between the cognitive depressive symptom dimension and any endpoints after Bonferroni correction.

Conclusions Somatic symptoms of depression at 12 months post-MI in patients at increased psychosocial risk predicted subsequent mortality. Psychosocial interventions aimed at improving cardiac prognosis may be enhanced by targeting somatic depressive symptoms, with particular attention to somatic symptom severity at 12 months post-MI.

(Received January 01 2011)

(Revised May 11 2011)

(Accepted May 14 2011)

(Online publication June 20 2011)


c1 Address for correspondence: S. Bekke-Hansen, M.Sc., Department of Psychology, Aarhus University, Jens Chr. Skous Vej 4, DK-8000 Aarhus, Denmark. (Email: