Journal Mobile Options
Table of Contents
Vol. 74, No. 3, 2005
Issue release date: April 2005
Psychother Psychosom 2005;74:179–184
(DOI:10.1159/000084003)

Stressful Life Events, Depression and Demoralization as Risk Factors for Acute Coronary Heart Disease

Rafanelli C. · Roncuzzi R. · Milaneschi Y. · Tomba E. · Colistro M.C. · Pancaldi L.G. · Di Pasquale G.
aDepartment of Psychology, University of Bologna, bDepartment of Cardiology, Bellaria Hospital, cDepartment of Cardiology, Bentivoglio Hospital, and dDepartment of Cardiology, Maggiore Hospital, AUSL Bologna, Bologna, Italy

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: While the effect of psychological stress and depression on the course of heart disease is commonly recognized, the relationship between recent life events, major depression, depressive symptomatology and the onset of acute coronary heart disease (CHD) has been less considered. The aim of this study was to investigate the presence of stressful life events, major and minor depression, recurrent depression and demoralization in the year preceding the occurrence of a first acute myocardial infarction (AMI) and/or a first episode of instable angina and to compare stressful life events, also related with mood disorders, in patients and healthy controls. Methods: 97 consecutive patients with a first episode of CHD (91 with AMI and 6 with instable angina) and 97 healthy subjects matched for sociodemographic variables were included. All patients were interviewed with Paykel’s Interview for Recent Life Events, a semistructured interview for determining the psychiatric diagnosis of mood disorders (DSM-IV), a semistructured interview for demoralization (DCPR). Patients were assessed while on remission from the acute phase. The time period considered was the year preceding the first episode of CHD and the year before the interview for controls. Results: Patients with acute CHD reported significantly more life events than control subjects (p < 0.001). All categories of events (except entrance events) were significantly more frequent. 30% of patients were identified as suffering from a major depressive disorder; 9% of patients were suffering from minor depression, 20% from demoralization. Even though there was an overlap between major depression and demoralization (12%), 17% of patients with major depression were not classified as demoralized and 7% of patients with demoralization did not satisfy the criteria for major depression. Independently of mood disorders, patients had a higher (p < 0.001) mean number of life events than controls. With regard to life events, the same significant difference (p < 0.001) compared to controls applied to patients with and without mood disorders. Conclusions: Our findings emphasize, by means of reliable methodology, the relationship between life events and AMI. These data, together with those regarding traditional cardiac risk factors, may have clinical and prognostic implications to be verified in longitudinal studies.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Reich P: How much does stress contribute to cardiovascular disease? J Cardiovasc Med 1983;8:825–831.
  2. Magni G, Corfini A, Berto F, Rizzardo R, Bombardelli S, Miraglia G: Life events and myocardial infarction. Aust NZ J Med 1983;13:257–260.
  3. Stokols D: Conflict-prone and conflict-resistant organizations; in Friedman HS (ed): Hostility Coping and Health. Washington, APA, 1992, pp 65–76.
  4. Ladwig KH, Kieser M, Konig J, Breithardt G, Borggrefe M: Affective disorders and survival after acute myocardial infarction: Results from the post-infarction late potential study. Eur Heart J 1991;12:959–964.
  5. Frasure-Smith N, Lesperance F, Talajic M: Depression following myocardial infarction: Impact on 6 month survival. JAMA 1993;270:1819–1825.
  6. Frasure-Smith N, Lesperance F, Talajic M: Depression and 18-month prognosis after myocardial infarction. Circulation 1995;91:999–1005.
  7. Bush DE, Ziegelstein RC, Tayback M, Richter D, Stevens S, Zahalsky H, Fauerbach JA: Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol 2001;88:337–341.
  8. Musselman DL, Evans DL, Nemeroff CB: The relationship of depression to cardiovascular disease. Arch Gen Psychiatry 1998;55:580–592.
  9. Rozanski A, Blumenthal JA, Kaplan J: Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:2192–2217.
  10. Kubzansky LD, Kawachi I: Going to the heart of the matter: Do negative emotions cause coronary heart disease? J Psychosom Res 2000;48:323–337.
  11. Barefoot JC, Schroll M: Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 1996;93:1976–1980.
  12. Anda R, Williamson D, Jones D, Macera C, Eaker E, Glassman A, Marks J: Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of US adults. Epidemiology 1993;4:285–294.
  13. Aromaa A, Raitasalo R, Reunanen A, Impivaara O, Helivaara M, Klenkt P, Lehtinen V, Joukamaa M, Maatela J: Depression and cardiovascular diseases. Acta Psychiatr Scand 1994;377(suppl):77–82.

    External Resources

  14. Rugulies R: Depression as predictor for coronary heart disease: A review and meta-analysis. Am J Prev Med 2002;23:51–61.
  15. Littman AB: A review of psychosomatic aspects of cardiovascular disease; in Fava GA, Freyberger H (eds): Handbook of Psychosomatic Medicine. Madison, International Universities Press, 1998, pp 261–293.
  16. Everson SA, Goldberg DE, Kaplan GA, Cohen RD, Pukkala E, Tuomilehto J, Salonen JT: Hopelessness and risk of mortality and incidence of myocardial infarction and cancer. Psychosom Med 1996;58:113–121.
  17. Everson SA, Kaplan GA, Goldberg DE, Salonen JT: Hopelessness and 4-year progression of carotid atherosclerosis: The Kupio ischemic heart disease risk factor study. Arteriosler Thromb Vasc Biol 1997;17:1490–1495.
  18. Appels A, Mulder P: Excess fatigue as a precursor of myocardial infarction. Eur Heart J 1988;9:758–764.
  19. Goldthorpe JH, Hope K: The Social Grading of Occupations. Oxford, Oxford University Press, 1974.
  20. Paykel ES: The Interview for Recent Life Events. Psychol Med 1997;27:301–310.
  21. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, American Psychiatric Association, 1994.
  22. Rafanelli C, Roncuzzi R, Finos L, Tossani E, Tomba E, Mangelli L, Urbinati S, Pinelli G, Fava GA: Psychological assessment in cardiac rehabilitation. Psychother Psychosom 2003;72:343–349.
  23. Freyberger HJ: Interview for Field Trials of Diagnostic Criteria for Psychosomatic Research (DCPR). Lübeck, University of Lübeck, 1995.
  24. Paykel ES: Life events, social support and depression. Acta Psychiatr Scand 1994;suppl 377:50–58.
  25. Appels A: Depression and coronary heart disease: Observations and questions. J Psychosom Res 1997;43:443–452.
  26. Sonino N, Navarrini C, Ruini C, Ottolini F, Paoletta A, Fallo F, Boscaro M, Fava GA: Persistent psychological distress in patients treated for endocrine disease. Psychother Psychosom 2004;73;78–83.
  27. Mangelli L, Fava GA, Grandi S, Grassi L, Ottolini F, Porcelli P, Rafanelli C, Rigatelli M, Sonino N: Assessing demoralization and depression in the setting of medical disease. J Clin Psychiatry, in press.
  28. Fava GA, Ruini C, Rafanelli C: Psychometric theory is an obstacle to the progress of clinical research. Psychother Psychosom 2004;73:145–148.
  29. Emmelkamp PMG: The additional value of clinimetrics needs to be established rather than assumed. Psychother Psychosom 2004;73:142–144.
  30. Faravelli C: Assessment of psychopathology. Psychother Psychosom 2004;73:139–141.
  31. Bech P: Modern Psychometrics in clinimetrics: Impact on clinical trials of antidepressants. Psychother Psychosom 2004;73:134–138.
  32. Hammen C, Mayol A, de Mayo R, Marks T: Initial symptom levels and the life-event depression relationship. J Abnorm Psychol 1986;95:114–122.
  33. Mayou R: The course and determinants of reactions to myocardial infarction. Br J Psychiatry 1979;134:588–594.
  34. Frasure-Smith N, Lesperance F, Talajic M: The impact of negative emotions on prognosis following myocardial infarction: Is it more than depression? Health Psychol 1995;14:388–398.
  35. Rosengren A, Orth-Gomer K, Wedel H, Wilhelmsen L: Stressful life events, social support, and mortality in men born in 1933. Br Med J 1993;307:1102–1105.
  36. Sonino N, Navarrini C, Ruini C, Fallo F, Boscaro M, Fava GA: Life events in the pathogenesis of hyperprolactinemia. Eur J Endocrinol 2004;151:61–65.
  37. Brown GW, Harris T: Establishing causal links; in Katschining H (ed): Life Events and Psychiatric Disorder. Cambridge, Cambridge University Press, 1986, pp 107–187.
  38. Fava GA, Kellner R: Prodromal symptoms in affective disorders. Am J Psychiatry 1991;148:823–830.
  39. Hurst MW: Life changes and psychiatric symptom development; in Barrett JE (ed): Stress and Mental Disorder. New York, Raven Press, 1979, pp 17–36.
  40. Bradburn NM, Rips LJ, Shevell SK: Answering autobiographical questions. Science1987;236:157–161.
  41. Baratta S, Colorio C, Zimmermann-Tansella Ch: Inter-rater reliability of the Italian version of the Paykel Scale for stressful life events. J Affect Dis 1985;8:279–282.
  42. Galeazzi GM, Ferrari S, Mackinnon A, Rigatelli M: Interrater reliability, prevalence, and relation to ICD-10 diagnoses of the Diagnostic Criteria for Psychosomatic research in consultation-liaison psychiatry patients. Psychosomatics 2004;45:386–393.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50