Psychosomatics 47:4, July-August 2006 http://psy.psychiatryonline.org 289 Minor Depression as a Cardiac Risk Factor After Coronary Artery Bypass Surgery CHIARA RAFANELLI, M.D., PH.D. RENZO RONCUZZI, M.D. YURI MILANESCHI,PSY.D. A few studies have investigated the role of psychosocial variables on clinical outcomes in coro- nary artery bypass grafting patients. The aims of this prospective study were 1) to assess clinical and subclinical distress in a consecutive sample of patients who underwent coronary artery by- pass grafting surgery at both a 1-month assessment and a 6- to 8-year follow-up visit; and 2) to investigate the relationship between psychological variables and coronary events. A consecutive series of 47 patients with recent coronary artery bypass grafting surgery was evaluated by means of observer-rated categories (both the Diagnostic and Statistical Manual [DSM] and the new Di- agnostic Criteria for Psychosomatic Research [DCPR]), and self-rated scales such as the Psy- chosocial Index. Survival analysis was used to characterize the clinical course of patients at the 6- to 8-year follow-up. One month after surgery, at the first psychological assessment, 36% of patients received a psychiatric diagnosis, and almost half of the sample met the criteria for a DCPR cluster. At follow-up, only abnormal illness behavior scores varied significantly from those at the first evaluation. Among the variables examined as potential risk factors for coronary events, only minor depression attained statistical significance. Psychological evaluation of pa- tients who underwent coronary artery bypass grafting surgery needs to incorporate both clinical (DSM) and subclinical (DCPR) methods of classification. Furthermore, the data suggest minor depression as a potential cardiac risk factor in coronary artery bypass grafting patients. The clinical approach to coronary artery bypass grafting patients should thus include not only major depressive symptoms but also minor depression. (Psychosomatics 2006; 47:289–295) Received February 13, 2005; revised July 26, 2005; accepted August 24, 2005. From the Dept. of Psychology, Univ. of Bologna, Bologna, Italy; and the Div. of Cardiology, Bellaria Hospital, Bologna, Italy. Address correspondence and reprint requests to Dr. Rafanelli, Dept. of Psychology, Univ. of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy. e-mail: chiara.rafanelli3@unibo.it Copyright  2006 The Academy of Psychosomatic Medicine I n the past decade, there has been an increasing aware- ness of the presence of psychosocial distress, such as anxiety and depression, after coronary artery bypass graft- ing. 1–11 Although there is vast literature regarding the effect of depression on the outcome of acute myocardial infarc- tion, 12–15 only a few studies have investigated the role of this psychological variable on clinical outcome of coronary artery bypass grafting. 5,8–10,16–21 Most of these studies as- sessed depression only by self-rated instruments, with dif- ferent cutoff points, to discriminate between levels of symptomatology; this was likely because of the large num- ber of patients and the consequent lack of time. Only Con- nerney et al., 10 who monitored, over 1-year period, 366 patients who had undergone coronary artery bypass graft- ing, measured major depressive disorder before discharge with a structured psychiatric interview based on DSM– IV. 22 None of these studies assessed either psychiatric dis-