scholarly journals Readmissions for Depression and Suicide Attempt following Stroke and Myocardial Infarction

2020 ◽  
Vol 10 (2) ◽  
pp. 94-104
Author(s):  
Laura K. Stein ◽  
Alana Kornspun ◽  
John Erdman ◽  
Mandip S. Dhamoon
Keyword(s):  
Myocardial Infarction ◽  
Suicide Attempt ◽  
Cox Regression ◽  
Vascular Events ◽  
Discharge Home ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of ◽  
Nationally Representative ◽  
History Of Depression

Background and Purpose: Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events. Methods: The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere. Results: Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25–1.79, p < 0.0001). History of depression (HR 3.70 [3.07–4.46]), alcoholism (2.04 [1.34–3.09]), and smoking (1.38 [1.15–1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37–0.56]) and discharge home (0.69 [0.57–0.83]) were associated with reduced hazards of readmission due to depression. Conclusions: IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.

Abstract 43: Readmission for Depression and Suicide Attempt Following Stroke and Myocardial Infarction

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
John H Erdman ◽  
Alana Kornspun ◽  
Laura K Stein ◽  
Kyle C Rossi ◽  
Stanley S Tuhrim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Suicide Attempt ◽  
Cox Regression ◽  
Severity Of Illness ◽  
Primary Diagnosis ◽  
Readmission Rates ◽  
Vascular Events ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference

Introduction: Depression after ischemic stroke (IS) and myocardial infarction (MI) is more common than in the general population and associated with morbidity and mortality. There is a lack of data on the relative risk of depression and suicide attempt (SA) comparing IS to MI, and nationally representative data is needed. Methods: The 2013 Nationwide Readmissions Database contains >14 million U.S. admissions. Using validated International Classification of Disease, 9 th Revision, Clinical Modification Codes in the primary diagnosis position, we identified index admission for IS (weighted n=434,495) and MI (weighted n=539,550) and readmission for depression and SA. To arrive at national estimates, we calculated weighted 30-, 60-, and 90-day readmission rates. We performed Cox Regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) for readmission for depression and SA up to 1 year following IS vs. MI, adjusting for age, depression recorded during the index event, sex, length of stay, income quartile of patient zip code, discharge disposition, alcoholism, estimated severity of illness, and smoking. Results: Readmission rates for depression were consistently higher at 30, 60, and 90 days after IS compared to MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%). There was no significant difference in SA readmissions. The HR for readmission due to depression was 1.62 ([1.37-1.92], p=2.49x10 -8 ) comparing IS to MI in an unadjusted model and 1.49 [1.25-1.79] in a fully adjusted model. History of depression (3.70 [3.07-4.46], p=2.00x10 -16) , alcoholism (2.04 [1.34-3.09], p = 8.16x10 -4) , and smoking (1.38 [1.15-1.64], p = 3.98 x10 -4 ) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37-0.55], p = 7.66 x10 -15 ) and discharge home (0.69 [0.57-0.83], p = 1.54 x10 -3 ) were associated with reduced risk of depression readmission. Conclusion: In conclusion, IS was associated with a greater hazard of readmission for depression compared to MI but there were no differences for SA. Though both are acute ischemic vascular events, the damage to the brain may contribute to depression pathogenesis, and the greater disability from stroke may contribute to higher rates of depression.

scholarly journals Impact of pre-admission depression on mortality following myocardial infarction

2017 ◽  
Vol 210 (5) ◽  
pp. 356-361 ◽  
Author(s):  
Jens Sundbøll ◽  
Morten Schmidt ◽  
Kasper Adelborg ◽  
Lars Pedersen ◽  
Hans Erik Bøtker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
Population Based ◽  
Prognostic Impact ◽  
Depression Diagnosis ◽  
All Cause Mortality ◽  
History Of ◽  
Rate Ratios ◽  
First Time ◽  
History Of Depression

BackgroundThe prognostic impact of previous depression on myocardial infarction survival remains poorly understood.AimsTo examine the association between depression and all-cause mortality following myocardial infarction.MethodUsing Danish medical registries, we conducted a nationwide population-based cohort study. We included all patients with first-time myocardial infarction (1995–2014) and identified previous depression as either a depression diagnosis or use of antidepressants. We used Cox regression to compute adjusted mortality rate ratios (aMRRs) with 95% confidence intervals.ResultsWe identified 170 771 patients with first-time myocardial infarction. Patients with myocardial infarction and a previous depression diagnosis had higher 19-year mortality risks (87% v. 78%). The overall aMRR was 1.11 (95% CI 1.07–1.15) increasing to 1.22 (95% CI 1.17–1.27) when including use of antidepressants in the depression definition.ConclusionsA history of depression was associated with a moderately increased all-cause mortality following myocardial infarction.

scholarly journals Autism risk following antidepressant medication during pregnancy

2017 ◽  
Vol 47 (16) ◽  
pp. 2787-2796 ◽  
Author(s):  
A. Viktorin ◽  
R. Uher ◽  
A. Reichenberg ◽  
S. Z. Levine ◽  
S. Sandin
Keyword(s):  
Cox Regression ◽  
Population Sample ◽  
Antidepressant Drugs ◽  
Antidepressant Medication ◽  
Population Based ◽  
Autism Spectrum ◽  
Relative Risks ◽  
Increased Risk ◽  
History Of ◽  
History Of Depression

BackgroundPrevious studies have examined if maternal antidepressant medication during pregnancy increase the risk of autism spectrum disorder (ASD) in the offspring, but the results have been conflicting.MethodsIn a population-based cohort of 179 007 children born in 2006 and 2007 and followed through 2014 when aged 7 and 8, we estimated relative risks (RRs) of ASD and 95% confidence intervals (CIs) from Cox regression in children exposed to any antidepressant medication during pregnancy, and nine specific antidepressant drugs. Analyses were adjusted for potential confounders and were conducted in the full population sample, and in a clinically relevant sub-sample of mothers with at least one diagnosis of depression or anxiety during life.ResultsThe adjusted RR of ASD in children of mothers who used antidepressant medication during pregnancy was estimated at 1.23 (95% CI 0.96–1.57), and at 1.07 (95% CI 0.80–1.43) in women with a history of depression or anxiety. Analyses of specific antidepressants initially revealed increased RRs of offspring ASD confined to citalopram and escitalopram (RR: 1.47; 95% CI 0.92–2.35) and clomipramine (RR: 2.86; 95% CI 1.04–7.82).ConclusionMedication with antidepressants during pregnancy does not appear to be causally associated with an increased risk of ASD in the offspring. Instead, the results suggest that the association is explained by factors related to the underlying susceptibility to psychiatric disorders. Based on these findings, the risk of ASD in the offspring should not be a consideration to withhold treatment with commonly used antidepressant drugs from pregnant women.

Abstract 22: Risk and Predictors of Depression Following Acute Ischemic Stroke in the Elderly: Comparison With Acute Myocardial Infarction

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Naomi Mayman ◽  
Laura K Stein ◽  
Stanley Tuhrim ◽  
Nathalie Jette ◽  
Mandip S Dhamoon
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
Cumulative Risk ◽  
The Elderly ◽  
Stroke Patients ◽  
Vascular Events ◽  
Post Stroke ◽  
Kaplan Meier ◽  
Post Stroke Depression ◽  
History Of

Introduction: Post-stroke depression (PSD) occurs commonly following stroke and is associated with worse outcomes and higher mortality. Previous research has not identified consistent predictors of PSD, and debate remains about whether PSD differs from other types of depression, including depression following other ischemic vascular events. Objective: We sought to comprehensively evaluate predictors of PSD in the US population and compare the hazard of developing PSD to post-myocardial infarction (MI) depression. Methods: Retrospective cohort study of 100% de-identified inpatient, outpatient, and subacute nursing Medicare data from 2016-2017 for US patients aged ≥65 years from July 1, 2016 to December 31, 2017. We calculated Kaplan-Meier unadjusted cumulative risk of depression up to 1.5 years following index admission. We performed Cox regression to report the hazard ratio for diagnosis of depression up to 1.5 years post-stroke vs. MI, as well as independent predictors of PSD, and controlled for patient demographics, comorbidities, length of stay and acute stroke interventions. Results: In fully adjusted models, stroke patients (n=174,901) were approximately 50% more likely than MI patients (n=193,418) to develop depression during the 1.5-year follow-up period (Kaplan-Meier cumulative risk 0.1596 ± 0.001 in stroke patients versus 0.0973 ± 0.000778 in MI patients, log-rank p<0.0001). History of anxiety was the strongest predictor of PSD, while discharge home was most protective. Female patients, White patients, and patients younger than 75 years were more likely to be diagnosed with depression post-stroke. Conclusions: Despite the similarities between MI and stroke, patients who suffer from stroke were significantly more likely to develop depression. There were several predictors of post-stroke depression, most significantly history of anxiety. Our findings lend credibility to a stroke-specific process causing depression and highlight the need for consistent depression screening in all stroke patients.

Does Depression Increase Risk for Noncompliance with Warfarin Therapy?

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5096-5096
Author(s):  
Urmeel H Patel ◽  
Mitchell Veith ◽  
Yijin Wert ◽  
Pramil Cheriyath
Keyword(s):  
Adverse Events ◽  
Therapeutic Range ◽  
Warfarin Therapy ◽  
Conflicts Of Interest ◽  
Categorical Variables ◽  
P Value ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of ◽  
History Of Depression

Abstract Introduction Management of warfarin therapy in an outpatient setting has been proven to be challenging despite specialized anticoagulation clinics. It is estimated that 40-50% of INR values are outside and, most commonly, below the therapeutic range. Extended periods of time spent outside the therapeutic INR range have been associated with an increased risk for morbidity and mortality. Sub-therapeutic INRs are associated with a higher risk for thromboembolism, which can lead to ischemic stroke and myocardial infarction; while supra-therapeutic INRs are associated with warfarin-induced hemorrhage, both of which can lead to an increased mortality. Furthermore, it has been found that patients with depressive symptoms have been associated with decreased adherence to any medical management when compared to non-depressed patients and patients with psychosocial or emotional factors are more often found to be outside therapeutic range while on warfarin therapy. However, whether depression has a direct effect on noncompliance with warfarin therapy has yet to be studied. This study intends to prove depression does increase the risk for noncompliance with warfarin therapy and, subsequently, increase their risk of adverse events due to decreased time-in-therapeutic range (TTR). Method A retrospective study was conducted on 91 patients from an outpatient anticoagulation clinic. INR data, past medical history of depression, demographics, and history of complications secondary to warfarin therapy were collected. Patients with history of depression were compared to patients without history of depression on their demographic variables, risk factors and the study outcomes. Chi-square tests were used to determine the significant difference between the two groups on categorical variables. The student t-tests were used to determine the significant difference between the two groups on continuous variables. A p-value ≤ 0.05 was regarded as significant. A logistic regression model was used to determine whether depression had an impact on keeping the patient’s INRs within the therapeutic range 70% of the time while on therapy. All the statistical analyses were completed by SAS version 9.2. Results We found that the group of patients with a history of depression were 67% less likely to have patients who had their INRs within the therapeutic range 70% of the time while on therapy when compared to patients without a history of depression (odds ratio=0.33, CI 0.116 – 0.935, p-value = 0.0370). Additionally, we found that patients with a history of depression had, on average, a lower TTR than patients without a history of depression (p-value = 0.0399). Conclusion The results reveal patients with a history of depression are at an increased risk for noncompliance with warfarin therapy when compared to patients without a history of depression. Furthermore, patients with a history of depression and on warfarin therapy would likely benefit from further interventions to increase their TTR and decrease their risks for adverse events. Disclosures No relevant conflicts of interest to declare.

scholarly journals Comparison between Macro & Micro Nutrient Intake in Depressed Patients with Healthy People

2019 ◽  
Author(s):  
Maryam Khosravi ◽  
Mahdieh Hosseinzadeh ◽  
Maryam Golzar ◽  
Reza Majdzadeh ◽  
Gity Sotoudeh
Keyword(s):  
Dietary Fiber ◽  
Fruits And Vegetables ◽  
Healthy People ◽  
Traumatic Experiences ◽  
Case Group ◽  
Depressed Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of ◽  
History Of Depression

Background: In recent years, the prevalence of depression has grown dramatically in the world. According to WHO reports, about 350 million people suffer from depression. In addition to the side effects of antidepressants, many patients are resistant to treatment with these drugs. One of the most important effective factors in the pathology of depression is the role of nutrition in controlling and preventing this disease. Therefore, the aim of this study was to investigate the macronutrient and micronutrient status in depressed patients and compare them with healthy people.  Methods: In this case-control study, 110 depressed patients were matched with 220 healthy controls based on their age, gender, and area of residence. Patients were selected by simple sampling method. In the case group, unipolar major depressive disorder was diagnosed by a psychiatrist using the DSM-IV criteria. Food intakes of all participants were obtained using reliable semi-quantitative food frequency questionnaires and analyzed with Nutritionist4 software. Anthropometric measurements including height, weight, and waist circumference were calculated for all participants.  Results: The participants included 260 women and 71 men. The two groups had a statistically significant difference in terms of occupation, history of depression, childhood traumatic experiences, and family history of depression (P < 0.05). Regarding the macronutrients and micronutrients, a significant difference was observed between the case and control groups in terms of vitamin C, vitamin K, and dietary fiber intake, which were lower in depressed patients. Conclusion: The results of this study indicated that intake of some micronutrients such as vitamins C, K, and dietary fiber may be associated with an increased risk of depression. Consumption of some micronutrients, mainly fruits and vegetables may be effective to control or prevent the risk of depression.

Sibling Alcohol Use Disorder Is Associated With Increased Risk for Suicide Attempt

2021 ◽  
pp. 216770262110250
Author(s):  
Mallory E. Stephenson ◽  
Sara Larsson Lönn ◽  
Jessica E. Salvatore ◽  
Jan Sundquist ◽  
Kenneth S. Kendler ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Suicide Attempt ◽  
Alcohol Use Disorder ◽  
Cox Regression ◽  
Population Based ◽  
Swedish Population ◽  
Sibling Pairs ◽  
Increased Risk ◽  
Using Data ◽  
Shared Genetic

The association between having a sibling diagnosed with alcohol use disorder (AUD) and risk for suicide attempt may be attributable to shared genetic liability between AUD and suicidal behavior, effects of environmental exposure to a sibling’s AUD, or both. To distinguish between these alternatives, we conducted a series of Cox regression models using data derived from Swedish population-based registers with national coverage. Among full sibling pairs (656,807 males and 607,096 females), we found that, even after we accounted for the proband’s AUD status, the proband’s risk for suicide attempt was significantly elevated when the proband’s sibling was affected by AUD. Furthermore, the proband’s risk for suicide attempt was consistently higher when the sibling’s AUD registration had occurred more recently. Our findings provide evidence for exposure to sibling AUD as an environmental risk factor for suicide attempt and suggest that clinical outreach may be warranted following a sibling’s diagnosis with AUD.

scholarly journals Prospective associations between ECG abnormalities and death or myocardial infarction in a cohort of 980 employed, middle-aged Swedish men

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Lennart Dimberg ◽  
Bo Eriksson ◽  
Per Enqvist
Keyword(s):  
Myocardial Infarction ◽  
Health Examination ◽  
Individual Level ◽  
Increased Risk ◽  
Significant Difference ◽  
Ethical Approval ◽  
Independent Association ◽  
Repeat Examination ◽  
Normal Ecgs ◽  
Ecg Abnormalities

Abstract Background In 1993, 1000 randomly selected employed Swedish men aged 45–50 years were invited to a nurse-led health examination with a survey on life style, fasting lab tests, and a 12-lead ECG. A repeat examination was offered in 1998. The ECGs were classified according to the Minnesota Code. Upon ethical approval, endpoints in terms of MI and death over 25 years were collected from Swedish national registers with the purpose of analyzing the independent association of ECG abnormalities as risk factors for myocardial infarction and death. Results Seventy-nine of 977 participants had at least one ECG abnormality 1993 or 1998. One hundred participants had a first MI over the 25 years. Odds ratio for having an MI in the group that had one or more ECG abnormality compared with the group with two normal ECGs was estimated to 3.16. 95%CI (1.74; 5.73), p value 0.0001. One hundred fifty-seven participants had died before 2019. For death, similarly no statistically significant difference was shown, OR 1.52, 95%CI (0.83; 2.76). Conclusions Our study suggests that presence of ST- and R-wave changes is associated with an independent 3–4-fold increased risk of MI after 25 years follow-up, but not of death. A 12-lead resting ECG should be included in any MI risk calculation on an individual level.

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