Psychosocial vulnerabilities to depression after acute coronary syndrome: The pivotal role of rumination in predicting and maintaining depression

Abstract

Psychosocial vulnerabilities may predispose individuals to develop depression after a signif-icant life stressor, such as an acute coronary syndrome (ACS).The aims are (1) to examine the interrelations among vulnerabilities, and their relation with changes in depressive symp-toms 3 months after ACS, (2) to prospectively assess whether rumination interacts with other vulnerabilities as a predictor of later depressive symptoms, and (3) to examine how these relations differ between post-ACS patients who meet diagnostic criteria for depression at baseline versus patients who do not. Within 1 week after hospitalization for ACS, and again after 3 months, 387 patients (41% female, 79.6% white, mean age 61) completed the Beck Depression Inventory (BDI) and measures of vulnerabilities (lack of pleasant events, dysfunctional attitudes, role transitions, poor dyadic adjustment). Exclu-sion criteria were a BDI score of 5-9, terminal illness, active substance abuse, cognitive impairment, and unavailability for follow-up visits. We used hierarchical regression mod-eling cross-sectionally and longitudinally. Controlling for baseline (in-hospital) depression and cardiovascular disease severity, vulnerabilities significantly predicted 3 month depres-sion severity. Rumination independently predicted increased depression severity, above other vulnerabilities (ß = 0.75, p < 0.001), and also interacted with poor dyadic adjustment (ß = 0.32, p < 0.001) to amplify depression severity. Among initially non-depressed patients, the effects of vulnerabilities were amplified by rumination. In contrast, in patients who were already depressed at baseline, there was a direct effect of rumination above vulnerabilities on depression severity. Although all vulnerabilities predict depression 3 months after an ACS event has occurred rumination plays a key role to amplify the impact of vulnerabilities on depression among the initially non-depressed, and maintains depression among those who are already depressed. © 2012 Denton, Rieckmann, Davidson and Chaplin.