Depression after heart attack: Threat perception has to be addressed

Patients who feel strongly threatened by their heart disease immediately after their heart attack have a higher risk of developing depressive symptoms. The data derived from this study can lead to better heart patient management.

"Survivors of heart attacks are three times more likely to develop depression during the first six months after their heart attack, than people with no heart disease. If left untreated this contributes to a worse prognosis, for instance further cardiac events and possibly death. The causes for this high prevalence of depression after heart attacks are still unclear," said Prof. Claus Vögele, Professor of Clinical and Health Psychology at the University of Luxembourg and lead author of the publication entitled "Cardiac Threat Appraisal and Depression after First Myocardial Infarction".

Thirty-six cardiac patients were interviewed five to fifteen days after their first heart attack, six to eight weeks later, and again six months later. They were questioned on their level of fatigue, general health, disease-specific symptoms, work, and family.  Depression levels were assessed with questionnaires and clinical diagnoses were established using a structured, clinical interview. To investigate their individual ways of coping with this experience, patients were questioned on rumination, affiliation seeking, threat minimisation, information seeking, and seeking meaning in religion.

The findings are among the first to show that the way patients think about their heart attack has an immediate effect on the likelihood of developing depression. For example, if they continue to perceive their heart attack as a serious threat then they are more likely to experience depression, even weeks after the attack. On the other hand, if patients have ways to focus their thoughts on their recovery and know how to ask for support from their friends and family, then this risk for depression is much reduced.

"These results can be used to help patients to have a more positive outlook on life, even after such a dramatic and life-threatening event", said Prof. Vögele, who is head of a research group on Self-regulation and Health at the University of Luxembourg. "Psychological interventions in the immediate time after the infarct, for instance during the first two weeks, may protect patients from developing depression, and thereby contribute to a smooth recovery."