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Psychosom Med. 2019 Jul/Aug;81(6):513-520. doi: 10.1097/PSY.0000000000000702.

The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up.

Author information

1
From the Institute of Clinical Medicine (Bürker, Gullestad, Fiane, Malt), University of Oslo; Department of Psychiatry of Old Age (Bürker), Oslo University Hospital - Ullevål; Departments of Psychosomatic Medicine (Bürker, Haraldsen), Cardiology (Gullestad, Gude, Relbo Authen, Grov, Andreassen), and Cardiothoracic Surgery (Fiane), Oslo University Hospital - Rikshospitalet; K.G. Jebsen Centre for Cardiac Research (Gullestad), University of Oslo; Centre for Heart Failure Research (Gullestad), Oslo University Hospital, Oslo, Norway; Department of Clinical Psychology (Havik), University of Bergen, Bergen, Norway; Department of Psychiatry (Dew), University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Psychology (Andersson), University of Oslo, Oslo, Norway; and Department of Research and Education (Malt), Oslo University Hospital - Rikshospitalet, Norway.

Abstract

OBJECTIVE:

Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified and whether they were differentially associated with mortality.

METHODS:

Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventory - version 1A [BDI-1A]), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni- and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables.

RESULTS:

Clinically significant depression was a significant predictor of mortality (hazard ratio = 2.088; 95% confidence interval = 1.366-3.192; p = .001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (hazard ratio = 1.982; 95% confidence interval = 1.220-3.217; p = .006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, whereas neither of the two subscales was an independent predictor of mortality in the multivariate analysis.

CONCLUSIONS:

Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.

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