Introduction:
Depression is associated with adverse health outcomes in women with myocardial infarction (MI). Little is known about modifiable psychosocial risk factors for depression in this population. We analyzed baseline data from an ongoing multicenter clinical trial to test the hypothesis that depressive symptom severity is associated with low mindfulness and high rumination, two psychosocial factors targeted by the mindfulness-based cognitive therapy (MBCT) program being tested.
Methods:
Women with MI reporting elevated stress levels ≥2 months post-MI are eligible for the trial. Participants complete baseline measures including demographics, medical history and validated measures of depressive symptoms (Patient Health Questionnaire [PHQ-9]), mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), rumination (Rumination-Reflection Questionnaire [RRQ]) and disease-specific quality of life (Seattle Angina Questionnaire [SAQ-7]). Pearson correlation coefficients and multivariable linear regression were used to identify correlates of baseline depressive symptoms.
Results:
The 127 participants had a mean age of 60.0 years (SD=12.8); 33.1% were racial or ethnic minorities and 16.5% were participating in cardiac rehabilitation. The mean PHQ-9 score was 7.5 (SD=4.7), 31.5% of participants had elevated depressive symptoms (PHQ-9≥10) and 23.6% were taking antidepressant medication. In univariate analyses, higher depressive symptoms were associated with higher rumination (r=.412, p<.001) and lower mindfulness (r=-.370, p<.001). In multivariable analysis, higher depressive symptoms were associated with higher rumination (B=.253, p=.005), financial strain (B=.180, p=.02), lower SAQ score (B=-.269, p=.001) and use of antidepressant medication (B=.283, p<.001). Mindfulness, age, race/ethnicity, marital status and cardiac rehab were not associated.
Conclusions:
About one-third of women reported clinically significant depressive symptoms after acute recovery from MI. Higher depressive symptoms were independently associated with higher levels of rumination. Future analyses will test whether hypothesized effects of MBCT on depression in post-MI women are mediated by reductions in negative thought patterns.
Psychosocial Risk Factors for Acute Myocardial Infarction
