Parker et al. (
1
) argued that in predicting cardiac readmission or death following an acute coronary
syndrome (ACS), “Timing is everything.” On the basis of multivariate logistic regression,
they reported that patients who developed a depressive episode in the month following
an ACS admission, whether incident or recurrent, had on average 7 times the odds (95%
confidence interval [CI] = 2.21–22.17) for ACS readmission or cardiac mortality compared
with patients with no depression before or after the ACS. Although not significant,
the same multivariate analysis indicated that patients with incident depression post-ACS
were potentially at much lower risk of ACS readmission or cardiac mortality than nondepressed
patients (odds ratio = .58, 95% CI = .14–2.43). Parker and colleagues concluded that
episodes of depression that emerge after an ACS, whether or not the post-ACS episodes
are incident or recurrent, put patients at significantly greater risk of poor cardiovascular
outcomes compared with patients without depression. The authors were not, but should
have been, concerned about the magnitude of the odds ratio for post-ACS depression
and, although nonsignificant, the direction of the effect for incident depression.To read this article in full you will need to make a payment
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References
- Timing is everything: The onset of depression and acute coronary syndrome.Biol Psychiatry. 2008; 64: 660-666
- 3rd ed. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates, Hilsdale, NJ2003
Article info
Publication history
Published online: March 23, 2009
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© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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- Improving Methodology Improves Timing: Reply to Thombs et al.Biological PsychiatryVol. 66Issue 3
- PreviewWe thank Thombs and colleagues for their close reading of our article, which has identified an issue related to the inclusion and coding of “dummy” variables for certain effects. By prompting a reexamination of our data, their letter has helped to clarify further the role of post–acute coronary syndrome (ACS) depression.
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