Depression vulnerabilities in patients with different levels of depressive symptoms after acute coronary syndromes

Background. Cognitive, behavioral, and interpersonal vulnerabilities have been studied in patients fulfilling diagnostic criteria for major depression and dysthymia. The extent to which these vulnerabilities are present in cardiac patients with mild to moderate depressive symptoms-a risk factor for mortality-is unknown. Moreover, few studies have examined interrelations among depression vulnerabilities. Methods: A consecutive cohort of 314 patients with acute coronary syndrome completed the Beck Depression Inventory (BDI) and measures of cognitive, behavioral, and interpersonal vulnerabilities (Dysfunctional Attitudes Scale, Pleasant Events Schedule for the Elderly, Dyadic Adjustment Scale, and an inventory of role transitions) within 1 week of hospital admission. Of the patients, 166 were classified as nondepressed (BDI score, 0-4), 91 as mildly depressed (BDI score, 10-16), and 57 as moderately to severely depressed (BDI score, > 16). Results: Compared with nondepressed patients, both mildly depressed and moderately to severely depressed patients exhibited higher mean levels of all vulnerabilities as well as a higher prevalence of more than one elevated vulnerability, defined by threshold scores. Vulnerabilities were only minimally interrelated (r = 0.01-0.25), and they were independently associated with mild and moderate depressive symptom status. Conclusions: This is the first study to show that cognitive, behavioral, and interpersonal depression vulnerabilities are uniquely associated with concurrent depressive symptoms. There appeared to be only modest overlap between vulnerabilities, supporting the idea that depression in medically ill patients is a multifaceted phenomenon, even in the presence of minimally elevated depressive symptoms. Longitudinal studies are required before causality and treatment implications can be addressed. Copyright (c) 2006 S. Karger AG, Basel.