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Prognostic significance of depressio...

Parakh, Kapil.

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Prognostic significance of depression after myocardial infarction.

紀錄類型:	書目-語言資料,印刷品 : Monograph/item
正題名/作者:	Prognostic significance of depression after myocardial infarction./
作者:	Parakh, Kapil.
面頁冊數:	246 p.
附註:	Source: Dissertation Abstracts International, Volume: 71-05, Section: B, page: 2940.
Contained By:	Dissertation Abstracts International71-05B.
標題:	Health Sciences, Medicine and Surgery. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3410045
ISBN:	9781109779349

Prognostic significance of depression after myocardial infarction.
Parakh, Kapil.

Prognostic significance of depression after myocardial infarction. - 246 p.

Source: Dissertation Abstracts International, Volume: 71-05, Section: B, page: 2940.

Thesis (Ph.D.)--The Johns Hopkins University, 2010.

Depression is prevalent in patients with myocardial infarction (MI) and has been associated with increased mortality. This study investigates the prognostic significance of various measures of depression assessed at different time points, accounting for severity of MI, anxiety, social support, physical health and adherence, in a cohort of MI patients admitted to the Johns Hopkins Bayview Medical Center located in East Baltimore.

ISBN: 9781109779349Subjects--Topical Terms:

1017756
Health Sciences, Medicine and Surgery.

Prognostic significance of depression after myocardial infarction.
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100 1 $a Parakh, Kapil. $3 1685084
245 1 0 $a Prognostic significance of depression after myocardial infarction.
300 $a 246 p.
500 $a Source: Dissertation Abstracts International, Volume: 71-05, Section: B, page: 2940.
500 $a Adviser: A. R. Sharrett.
502 $a Thesis (Ph.D.)--The Johns Hopkins University, 2010.
520 $a Depression is prevalent in patients with myocardial infarction (MI) and has been associated with increased mortality. This study investigates the prognostic significance of various measures of depression assessed at different time points, accounting for severity of MI, anxiety, social support, physical health and adherence, in a cohort of MI patients admitted to the Johns Hopkins Bayview Medical Center located in East Baltimore.
520 $a Symptoms of depression measured by the Beck Depression Inventory (BDI) were more prevalent than major depression at the time of MI and four months after MI. Compared to major depression, BDI was more closely associated with left ventricular dysfunction. Both measures were associated with anxiety; poor quality of life; and reduced adherence to recommended medications, diet and exercise 4 months after MI.
520 $a Major depression at the time of MI was associated with substantially increased mortality in multivariate models but this relationship had borderline statistical significance. Adjustment for co-morbidities, physical health, MI severity and treatment explained a substantial portion of the risk associated with major depression while anxiety and perceived social support did not account for any additional risk. Adherence to regular exercise (but not to other behaviors) accounted for only some of the risk associated with major depression, but was not the major mediator. These results suggest that major depression at the time of MI increases the risk of post-MI mortality, but after adequate accounting for medical illness, the residual risk may be lower than previously estimated.
520 $a Major depression four months after MI was not associated with even minimally increased subsequent mortality. Symptoms of depression as assessed by BDI (either as a continuous variable or dichotomized at 10 or 13) were not consistently associated with mortality at the time of MI or four months after MI after adjusting for co-morbidities, MI severity and treatment. BDI was associated with increased risk in models adjusted for demographics only, however, confounding by co-morbidities, MI severity and treatment accounted for most of the risk associated with BDI.
520 $a In terms of constructs, the absence or presence of major depression, rather than presence of symptoms based on the BDI, may be more useful. Unlike BDI, major depression seemed to be less affected by the severity of medical illness. This may be because the SCID is administered by trained personnel and incorporates symptoms preceding the MI while the BDI relies on self-report and focuses on symptoms at the time of MI. Furthermore, major depression is a clinical condition that warrants treatment regardless of the association of depression with mortality.
520 $a These findings suggest a complex and nuanced relationship between post MI depression and long term mortality. Co-morbidities, MI characteristics, MI treatment and physical health seem to account for most of the increased mortality risk associated with major depression or BDI the residual risk associated with depression may be smaller than previously estimated. These findings, together with prior studies, suggest that treatment of underlying atherosclerosis and co-morbidities may be the best approach to reduce the risk that occurs in patients with depression.
590 $a School code: 0098.
650 4 $a Health Sciences, Medicine and Surgery. $3 1017756
650 4 $a Psychology, Clinical. $3 524864
650 4 $a Health Sciences, Epidemiology. $3 1019544
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710 2 $a The Johns Hopkins University. $3 1017431
773 0 $t Dissertation Abstracts International $g 71-05B.
790 1 0 $a Sharrett, A. R., $e advisor
790 $a 0098
791 $a Ph.D.
792 $a 2010
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3410045