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November 13, 2001
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Depressed Heart Attack Survivors Unlikely To Change Behavior

Some depressed heart attack survivors are so convinced they'll never be healthy again that their belief becomes a self-fulfilling prophecy. A Johns Hopkins study demonstrates that defeatist attitudes lead to unwillingness to alter unhealthy habits and that this, more than physical status, puts them at risk for early death. Results will be presented Nov. 13 at the American Heart Association's annual Scientific Sessions in Anaheim, Calif.

Researchers studied 160 men and women with an average age of 65 recovering from heart attacks. All were evaluated for depression within two to five days of their hospitalizations using standard psychiatric surveys. Four months later, the surviving patients were re-evaluated to see if they were adopting healthier behaviors as recommended by their physician.

Depression was observed in 31 patients (20 percent). Within that group, the worse the patients perceived their health to be, the higher their levels of depression, hypertension and diabetes. They also were more likely to have had a prior heart attack, high blood pressure and a higher degree of heart dysfunction after the heart attack.

"Only patients with post-heart attack depression showed a significant relationship between their perceived physical health status and adherence behavior," says David E. Bush, M.D., senior author of the study and assistant professor of medicine at Johns Hopkins Bayview Medical Center. "Depressed patients think they're in poor physical health and that changing their behavior isn't going to make a difference. Efforts to change their perceptions may enhance compliance."

Post-heart attack depression is a significant clinical problem that affects 15 to 20 percent of patients, Bush says. One of his earlier studies showed that patients with even low levels of depression had increased death rates.

"Patients who are depressed die at rates four and five times higher than those who aren't, so we have to examine whether their psyche plays a role, or if they're just sicker," Bush says. "We need to look for biological markers that may associate with depression."

Other study authors were M. Brandes; J.A. Fauerbach; R.C. Ziegelstein; J.W. Lawrence; and A.G. Bryant.

Abstract #113213: "Poor Perceived Physical Health Predicts Poor Adherence to Risk Modifying Behaviors in Patients with Post-Myocardial Infarction Depression."

Related Links:

Johns Hopkins Bayview Medical Center - Division of Cardiology

American Heart Association Scientific Sessions

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