Association of recognized and unrecognized myocardial infarction with depressive and anxiety disorders in 125,988 individuals: a report of the LifeLines Cohort Study

ABSTRACT:

Objectives: 
No previous study has focused on recognition of myocardial infarction (MI) and the presence of both depressive and anxiety disorders in a large population-based sample. The aim of this study was to investigate the association of recognized MI (RMI) and unrecognized MI (UMI) with depressive and anxiety disorders.

Methods: 
Analyses included 125,988 individuals enrolled in the Lifelines study. Current mental disorders according to the DSM-IV were assessed with the Mini International Neuropsychiatric Interview. UMI was detected using electrocardiography (ECG) in participants who did not report a history of MI. The classification of RMI was based on self-reported MI history together with either the use of antithrombotic medications or ECG signs of MI. Analyses were adjusted for age, sex, smoking, somatic comorbidities, and physical health-related quality of life as measured by the RAND 36-Item Health Survey in different models.

Results: 
Participants with RMI had significantly higher odds of having any depressive and any anxiety disorder as compared with participants without MI (depressive disorder: OR=1.86; 95%CI:1.38-2.52; anxiety disorder: OR=1.60; 95%CI:1.32-1.94) after adjustment for age and sex. Participants with UMI did not differ from participants without MI (depressive disorder: OR=1.60; 95%CI:0.96-2.64; anxiety disorder: OR=0.73; 95%CI:0.48-1.11). After additional adjustment for somatic comorbidities and low physical health-related quality of life, the association between RMI with any depressive disorder was no longer statistically significant (OR=1.18; 95% CI:0.84-1.65), but the association with any anxiety disorder remained (OR=1.27; 95%CI:1.03-1.57).

Conclusions: 
Recognition of MI appears to play a major role in the occurrence of anxiety, but not depressive, disorders.