Taking depression to heart

Mental state can play a crucial role in physical health — medical professionals have long known about the connection between anxiety and the immune system, for example. Now researchers at Tel Aviv University have found that mental health can also interfere with the heart.

Heart attack patients who also suffer from depression are more likely to be readmitted for cardiac events and chest pains in the future, and have 14 percent more days of hospitalization than their happier counterparts, says researcher Vicki Myers of TAU's Sackler Faculty of Medicine. Along with Dr. Yariv Gerber and other members of the Israel Study Group of First Acute Myocardial Infarction, Myers examined the association between depressive symptoms in heart attack patients and hospital admissions more than a decade after the initial attack.

These findings have long-term ramifications, says Myers. Spending more time in the hospital, these patients are a massive financial burden on health services, but an investment in extra psychiatric support may have a large positive payoff.

The study was funded by the Israel National Institute for Health Policy and Health Services Research and has been published in the Journal of Psychosomatic Research.

Most studies examining the connection between heart attack recovery and mental health have only included short term follow up, says Myers. To study the effect of depression on the long-term health of heart attack patients, the researchers used data collected from 632 heart attack patients under the age of 65 admitted to Israeli hospitals between 1992 and 1993, comparing their recoveries using follow-up data through 2005.

Although a large percentage of people who survive a heart attack will be re-admitted to the hospital at some point, people identified as at least "mildly depressed" during their first hospital stay were far more likely to be re-hospitalized later with further cardiac health problems. Patients with a higher depression score spent 14 percent more time in the hospital than those with a low score. Data were controlled for measures of co-morbidity, including other illnesses and risk factors such as smoking and socioeconomic status.

Post-heart-attack lifestyle choices played a major role in this relationship, explains Myers. Most heart attack patients are offered rehabilitation services, and are advised to change their lifestyle to include exercise, diet, and smoking cessation programs. Depressed patients are far less likely to avail themselves of rehab services, or elect to make life changes themselves, she says. Overall, depressed patients were 20 percent less likely to be physically active after suffering a heart attack, 26 percent less likely to participate in a cardiac rehabilitation program, and 25 percent less likely to quit smoking.

"The message is that doctors cannot ignore psychological factors in patients who have had a heart attack. Patients who exhibit signs of depression need to be followed more closely, and may need extra help in following lifestyle recommendations. Ignoring this problem weighs heavily on health services," she adds.

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