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Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study.
BMC Psychiatry. 2019 02 04; 19(1):57.BP

Abstract

BACKGROUND

Depressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD.

METHODS

Based on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways. We screened for univariable association with response, using either analysis of (co)variance or logistic regression, respectively, both adjusted for baseline HADS-D value and treatment group. To guard against overfitting, multivariable association was evaluated by a linear or binomial (generalised) linear model with lasso regularisation, a machine learning approach. Outcome measures were the change in continuous HADS-D depression scores, as well as three established binary criteria. The Charlson Comorbidity Index (CCI) was calculated to assess possible influences of comorbidities on our results and was also entered in our machine learning approach.

RESULTS

Higher age (p = 0.002), unknown previous myocardial infarction (p = 0.013), and a higher heart rate variability during numeracy tests (p = .020) were univariably associated with a favourable depression outcome, whereas hyperuricemia (p ≤ 0.003), higher triglycerides (p = 0.014), NYHA class III (p ≤ 0.028), state after resuscitation (p ≤ 0.042), intake of thyroid hormones (p = 0.007), antidiabetic drugs (p = 0.015), analgesic drugs (p = 0.027), beta blockers (p = 0.035), uric acid drugs (p ≤ 0.039), and anticholinergic drugs (p = 0.045) were associated with an adverse effect on the HADS-D depression score. In all analyses, no significant differences between study arms could be found and physical comorbidities also had no significant influence on our results.

CONCLUSION

Our findings may contribute to identification of somatic and sociodemographic predictors of depression outcome in patients with CAD. The unexpected effects of specific medication require further clarification and further research is needed to establish a causal association between depression outcome and our predictors.

TRIAL REGISTRATION

www.clinicaltrials.gov NCT00705965 (registered 27th of June, 2008). www.isrctn.com ISRCTN76240576 (registered 27th of March, 2008).

Authors+Show Affiliations

Department of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany. frank.vitinius@uk-koeln.de.Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany. steffen.escherich@uk-koeln.de.Department of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany.German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany.Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany.German Research Center of Environmental Health, Helmholtz Zentrum Muenchen, Institute of Epidemiology, Oberschleiβheim, Germany.Department of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany.Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Mainz, Mainz, Germany.Department of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany.Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Universitaet München, Munich, Germany.Department of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30717711

Citation

Vitinius, Frank, et al. "Somatic and Sociodemographic Predictors of Depression Outcome Among Depressed Patients With Coronary Artery Disease - a Secondary Analysis of the SPIRR-CAD Study." BMC Psychiatry, vol. 19, no. 1, 2019, p. 57.
Vitinius F, Escherich S, Deter HC, et al. Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study. BMC Psychiatry. 2019;19(1):57.
Vitinius, F., Escherich, S., Deter, H. C., Hellmich, M., Jünger, J., Petrowski, K., Ladwig, K. H., Lambertus, F., Michal, M., Weber, C., de Zwaan, M., Herrmann-Lingen, C., Ronel, J., & Albus, C. (2019). Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study. BMC Psychiatry, 19(1), 57. https://doi.org/10.1186/s12888-019-2026-6
Vitinius F, et al. Somatic and Sociodemographic Predictors of Depression Outcome Among Depressed Patients With Coronary Artery Disease - a Secondary Analysis of the SPIRR-CAD Study. BMC Psychiatry. 2019 02 4;19(1):57. PubMed PMID: 30717711.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study. AU - Vitinius,Frank, AU - Escherich,Steffen, AU - Deter,Hans-Christian, AU - Hellmich,Martin, AU - Jünger,Jana, AU - Petrowski,Katja, AU - Ladwig,Karl-Heinz, AU - Lambertus,Frank, AU - Michal,Matthias, AU - Weber,Cora, AU - de Zwaan,Martina, AU - Herrmann-Lingen,Christoph, AU - Ronel,Joram, AU - Albus,Christian, Y1 - 2019/02/04/ PY - 2017/12/05/received PY - 2019/01/15/accepted PY - 2019/2/6/entrez PY - 2019/2/6/pubmed PY - 2019/12/4/medline KW - Depression - mental disorders - coronary heart disease - psychotherapy - type D personality SP - 57 EP - 57 JF - BMC psychiatry JO - BMC Psychiatry VL - 19 IS - 1 N2 - BACKGROUND: Depressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD. METHODS: Based on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways. We screened for univariable association with response, using either analysis of (co)variance or logistic regression, respectively, both adjusted for baseline HADS-D value and treatment group. To guard against overfitting, multivariable association was evaluated by a linear or binomial (generalised) linear model with lasso regularisation, a machine learning approach. Outcome measures were the change in continuous HADS-D depression scores, as well as three established binary criteria. The Charlson Comorbidity Index (CCI) was calculated to assess possible influences of comorbidities on our results and was also entered in our machine learning approach. RESULTS: Higher age (p = 0.002), unknown previous myocardial infarction (p = 0.013), and a higher heart rate variability during numeracy tests (p = .020) were univariably associated with a favourable depression outcome, whereas hyperuricemia (p ≤ 0.003), higher triglycerides (p = 0.014), NYHA class III (p ≤ 0.028), state after resuscitation (p ≤ 0.042), intake of thyroid hormones (p = 0.007), antidiabetic drugs (p = 0.015), analgesic drugs (p = 0.027), beta blockers (p = 0.035), uric acid drugs (p ≤ 0.039), and anticholinergic drugs (p = 0.045) were associated with an adverse effect on the HADS-D depression score. In all analyses, no significant differences between study arms could be found and physical comorbidities also had no significant influence on our results. CONCLUSION: Our findings may contribute to identification of somatic and sociodemographic predictors of depression outcome in patients with CAD. The unexpected effects of specific medication require further clarification and further research is needed to establish a causal association between depression outcome and our predictors. TRIAL REGISTRATION: www.clinicaltrials.gov NCT00705965 (registered 27th of June, 2008). www.isrctn.com ISRCTN76240576 (registered 27th of March, 2008). SN - 1471-244X UR - https://www.unboundmedicine.com/medline/citation/30717711/Somatic_and_sociodemographic_predictors_of_depression_outcome_among_depressed_patients_with_coronary_artery_disease___a_secondary_analysis_of_the_SPIRR_CAD_study_ L2 - https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2026-6 DB - PRIME DP - Unbound Medicine ER -