Patients who are clinically depressed one month after coronary artery bypass grafting surgery are more likely to have chest pain and other cardiac problems five years afterward than patients who do not have postsurgical depression, according to an article in the November-December issue of Psychosomatics. The correlation was more pronounced in men than in women.

"Previous research suggests that one third of coronary artery bypass patients are depressed at some point shortly after surgery and that depression leads to poorer outcomes," said lead author Louis Borowicz Jr., M.S., of the Johns Hopkins Hospital. "Our findings suggest specifically that depression one month after coronary bypass surgery is an important risk factor for continued cardiac problems, especially angina."

For the study, 172 patients were interviewed before coronary artery bypass grafting and again at one month, one year, and five years after surgery. At each point, the researchers used a standard questionnaire to assess the study participants' level of depression and obtained detailed medical histories. Five years after surgery, data for 117 of the original 172 patients were available for analysis.

The researchers found that 32 percent of the patients were depressed before surgery, 28 percent were depressed one month after surgery, 21 percent were depressed one year after surgery, and 16 percent were depressed five years after surgery.

Higher depression scores at all four points were associated with the presence of angina at five years, with the strongest association found for depression at one month after surgery. The association between depression and cardiac problems existed even after adjustment for demographic, medical, and surgical factors.

Unexpectedly, the strong relation between depression one month after surgery and negative cardiac outcome was not found for women. At five years’ follow-up, both depressed and non-depressed women reported approximately the same, relatively high level of angina. However, women made up only 38 of the original 172 patients, a low proportion.

An estimated 800,000 coronary artery bypass grafting surgeries are performed each year worldwide, the authors reported. The authors suggest that long-term outcomes after coronary artery bypass surgery might be enhanced if patients are evaluated for depression one month after surgery and if treatment for depression is given as needed.