Presurgical depression predicts medical morbidity 6 months after coronary artery bypass graft surgery.

摘要

OBJECTIVE: Depression has been related to poor medical prognosis in patients with coronary artery disease and to diminished quality of life after coronary artery bypass graft surgery (CABG). However, prior studies have not fully examined the impact of depression on medical outcomes after CABG. The purpose of this study was to determine the independent contribution of presurgical depression to short-term medical outcome after CABG. METHODS: Medical, surgical, and psychosocial risk factors were assessed before surgery in 89 male veterans undergoing CABG. In addition, patients completed the Beck Depression Inventory. Medical, surgical, and psychological/quality-of-life outcomes were determined at 6 months of follow-up by telephone interview and review of medical records. RESULTS: Of the 89 patients studied, 25 scored 10 or greater on the Beck Depression Inventory. The study population was dichotomized on the basis of this cutoff point. A medical prediction model was developed for each outcome of interest,based on the range of medical, surgical, and psychosocial risk indices assessed. The dichotomized depression index was added to these prediction models as a final step. This depression index was found to independently predict cardiac hospitalizations at 6 months (chi(2) = 4.24, p <.04), continued surgical pain at 6 months (chi(2) = 6.36, p <.01), and failure to return to previous activity at 6 months (chi(2) = 15.04, p <.0001). Presurgical depression also predicted depressed affect at 6 months (chi(2) = 13.16, p <.0003). CONCLUSIONS: Depression is an important independent contributor to medical and psychosocial morbidity up to 6 months after CABG. These findings warrant replication with larger and more diverse populations.