Survivors of myocardial infarction who develop major depression are 50 percent more likely to have a second cardiac hospitalization within a year and three times more likely to have a heart-related death, according to a report from Johns Hopkins University published online by the US Agency for Healthcare Research and Quality.

“Although there is not much time to do a full psychiatric assessment of heart attack patients in the hospital, it is important to evaluate for depression because of the impact on the patient’s quality of life and future medical health,” said study co-lead author and cardiologist David Bush, MD.. He acknowledged that it can be really hard to tell who is most likely to get depressed because the average patient is recuperating and ready to go home from the hospital after 72 hours, and many symptoms of depression develop later.

Co-lead study author Roy Ziegelstein, MD, described depression after myocardial infarction as a complex interaction of neural hormones, biological changes, and sensory perceptions that medicine has only begun to study and explain. “It is far more complex an issue than just being sad or feeling blue for a short period,” he said. “What we’re talking about here is a serious illness.”

The study findings are contained in the report entitled “Evidence Report on Post-Myocardial Infarction Depression,” which is available on the Internet at http://www.ahrq.gov/clinic/epcsums/midepsum.htm.

The report was released by the United States Department of Health and Human Services’ Agency for Healthcare Research and Quality, which funded the research, and emphasizes that physicians should have a high level of suspicion for development of depression in these patients while further research clarifies risk factors and mechanisms underlying depression in this population.