Effects of depression and anxiety on mortality and quality-of-life 4 months after myocardial infarction Deirdre Lane a , Douglas Carroll a, *, Christopher Ring a , D. Gareth Beevers b , Gregory Y.H. Lip b a School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK b University Department of Medicine, City Hospital NHS Trust, Birmingham B18 7QH, UK Received 14 February 2000; accepted 5 July 2000 Abstract Objective: The purpose of this study was to determine the impact of depression and anxiety on mortality and quality-of-life in patients hospitalized for an acute myocardial infarction (MI). Methods: Questionnaire measures of depression and anxiety were completed during hospitalization by 288 MI patients. The main outcomes were mortality and quality-of-life, assessed by the Dartmouth COOP charts, at 4 months. Results: A total of 25 patients died, 22 from cardiac causes, during the 4-month follow- up. Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality. Severity of infarction, extent of heart failure, and a longer stay in hospital predicted mortality. Symptoms of depression and anxiety predicted 4-month quality-of-life among survivors, as did gender, partner status, occupational status, living alone, previous exercise behaviour, length of hospital admission, and Peel Index scores. In a multiple regression model, depression emerged as the strongest predictor of quality-of-life. State anxiety, severity of infarction, and partner status also entered the model. Conclusion: Neither depression nor anxiety predicted mortality 4 months after MI. Both depression and anxiety predicted quality-of- life at 4 months among survivors. D 2000 Elsevier Science Inc. All rights reserved. Keywords: Depression; Anxiety; Myocardial infarction; Mortality; Quality-of-life Introduction Depression and anxiety are prevalent following myocar- dial infarction (MI) [1–3]. Further, depression has been reported to predict subsequent short-term mortality, within the first 6 months, among MI patients [4,5], although, in one case, the association between depression and mortality did not withstand correction for disease severity [5]. Other studies have failed to find a relationship between depression and short-term mortality following MI [6–8]. In contrast, anxiety has been little studied in this context, although it has been observed to predict in-hospital mortality [9]. Given the putative clinical importance of depression and anxiety following MI [10,11], the inconsistent outcomes for the former and the scant data on the latter suggest the need for further study. There has also been little systematic research on the quality-of-life of patients following MI [11], although there is some evidence that patients who are depressed following an MI are less likely to return to work [3] and to resume previous sexual activity [12]. In the two studies, which have directly examined this issue, depression was found to be the best predictor of quality-of-life among MI survivors in one [13], and emotional distress (a combina- tion of anxiety and depression) predicted quality-of-life in the other [8]. The present study examined the relationship between depression and anxiety in hospital and mortality 4 months following MI. In addition, the study was concerned with the impact of depression and anxiety on the quality-of-life of survivors. * Corresponding author. Tel.: +44-121-414-7240; fax: +44-121-414- 4121. E-mail address: carrolld@bham.ac.uk (D. Carroll). Journal of Psychosomatic Research 49 (2000) 229 – 238 0022-3999/00/$ – see front matter D 2000 Elsevier Science Inc. All rights reserved. PII:S0022-3999(00)00170-7