Table 2.

Studies of depression and anxiety and coronary heart disease. References in the table are given on the BMJ website

Author, year, countryTotal sample (% women)Age at entryExposureFollow up (years)No of eventsType of eventsAdjustmentsRelative risk*Summary
Prospective aetiological studies
Hallstrom 1986w20 Sweden795 (100)38-54Depression (Hamilton and psychiatric interview)1275Non-fatal MI + angina + ischaemic changes on electrocardiographAge, social class, marital status, conventional risk factors5.4* severity of depression predicted angina but not other outcomes++
Hagman 1987w21 Sweden5735 (0)55 (mean)Anxiety (“stress”)2-7162Angina with or without MIAge, smoking, blood pressure, cholesterol, relativeweight Strong predictor for angina alone+
Haines 1987w22 UK1457 (0)40-64Phobic anxiety (Crown-Crisp)10113Fatal CHD + non-fatal MIfibrinogen, cholesterol, factor VII, systolic blood pressure3.77* for fatal CHD++
Appels 1990w23 Netherlands3877 (0)39-65Depression4.259Non-fatal MI + unstable angina + anginaAge, smoking, blood pressure, cholesterol1.86* for unstable angina for combination of low mood, low energy, hopelessness, poor sleep (termed “vital exhaustion”)+
Anda 1993w24 USA2832 (52)45-77Depression (General Well Being)12394Fatal CHD + non-fatal CHD hospitalisationsAge, sex, race, education, marital status, smoking, blood pressure, cholesterol, body mass index, alcohol, exercise1.6*+
Aromaa 1994w25 Finland5355 (55)40-64Depression (GHQ and PSE)6.691Fatal CHDAge, pre-existing cardiovascular disease3.36* (5.52 in those with pre-existing cardiovascular disease)++
Kawachi 1994w26 USA33999 (0)42-77Phobic anxiety (Crown Crisp)2168Fatal CHD + non-fatal MIAge, smoking, blood pressure, cholesterol, body mass index, diabetes, parental history of MI, alcohol, exercise3.01* (6.08 when sudden cardiac death examined)++
Everson 1996w27 Finland2428 (0)42-60Hopelessness695Non-fatal MIAge, smoking, blood pressure, cholesterol education, income, exercise, alcohol, lipids, social supports, depression2.05*++
Wassertheil-Smoller 1996w28 USA4367 (53)72 (mean)Depression (CES-D)4.5321Non-fatal MI + non-fatal strokesAge, smoking, baseline depression, sex, race, randomisation group, education, history of stroke, MI, diabetes, and baseline ADL1.18* per 5 unit increase in depression score (baseline scores alone did not predict events)+
Barefoot 1996w29 Denmark730 (44)50 or 60Depression (MMPI-obvious depression scale)27122Non-fatal MIAge, conventional CHD risk factors, baseline CHD1.7* for 2 SD difference in depression score+
Kubzansky 1997w30 USA1759 (0)21-80Social conditions worry scale20323Fatal CHD + non-fatal MI + anginaAge, smoking, blood pressure, cholesterol, body mass index, family history, alcohol1.23* per 1 point increase in social conditions worry scale+
Prognostic studies
Ahern 199031 USA353Depression (Beck), anxiety (Spielberger)12Fatal CHDAge, left ventricular dysfunction and previous MI1.3* for depression+
Kop 199432 Netherlands127 (17) patients 2 weeks after coronary angioplasty56 (SD 9)Maastricht questionnaire for vital exhaustion1.529Fatal CHD + non-fatal MI + further revascularisation + increase in coronary atherosclerosis + new anginaAge, sex, smoking, blood pressure, cholesterol, severity of coronary artery disease, clinical presentation2.34 (P=0.06)+
Ladwig 199433 Germany377 (0) 17-21 days after acute MI29-65Depression (interview)0.5Angina, not returning to work, continuing to smokeAge, social class, recurrent infarction, rehabilitation, cardiac events and helplessness2.31* for the effect on angina; depression predicted all outcomes++
Frasure-Smith 1995w34 USA222 (21) patients 5-15 days after acute MI24-88Depression (diagnostic interview schedule)1.521All cause mortality and fatal CHDAge, Killip class, premature ventricular contractions and previous MI6.64* effect of depression higher in those with (10 premature contractions per hour++
Barefoot 1996w35 USA1250 (18) patients with angiographic disease52 (mean)Depression (Zung)19.4604All cause mortality and fatal CHDDisease severity, initial treatment1.66*, 1.84* and 1.72* in three follow up periods (year 1, 5-10 and >10 respectively)+
Denollet 1996w36 Belgium303 (12) patients with angiographic disease31-79Type D personality (suppression of emotional distress), depression, social alienation7.938All cause mortality and fatal CHDLeft ventricular function, number of diseased vessels, low exercise tolerance, lack of thrombolytic therapy4.1* for type D and 2.7* for depression++
  • CHD=coronary heart disease; MI=myocardial infarction; CES-D=Center for Epidemiological Studies-Depression scale; GHQ=general health questionnaire; PSE=present state examination; MMPI=Minnesota multiphasic personality inventory.

  • * P<0.05.

  • †0=no association–that is, relative risk not significantly different from unity;

  • +=moderate association (relative risk >1≤2.0);

  • ++=strong association (relative risk >2.0) association.