Psychosocial vulnerabilities to depression after acute coronary syndrome: the pivotal role of rumination in predicting and maintaining depression
Open accessAbstract
Psychosocial vulnerabilities may predispose individuals to develop depression after a significant 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 symptoms 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). Exclusion 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 modeling cross-sectionally and longitudinally. Controlling for baseline (in-hospital) depression and cardiovascular disease severity, vulnerabilities significantly predicted 3 month depression severity. Rumination independently predicted increased depression severity, above other vulnerabilities (β = 0.75, p < 0.001), and also interacted with poor dyadic adjustment (β = 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.
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A similar previous study in ACS patients found a correlation of r=0.49 between baseline brooding and depression at 3 month follow-up.
“A similar previous study in ACS patients found a correlation of r=0.49 between baseline brooding and depression at 3 month follow-up (Denton et al., 2012)”
From Perseverative negative thinking predicts depression in people with acute coronary syndrome (2019) · cites this paper as Denton et al., 2012
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Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination
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Perseverative negative thinking predicts depression in people with acute coronary syndrome
Trick, L., Watkins, E. R., Henley, W., Gandhi, M. M., & Dickens, C. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.06.012 · Cited by 11 · see citing works
- Authors
- Denton, E.-G. D., Rieckmann, N., Davidson, K. W., & Chaplin, W. F.
- Affiliations
- St. John's University (US)
- Charité – Universitätsmedizin Berlin (DE)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Denton, Ellen-ge D.
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2012
- Volume
- 3
- Pages
- 288-288
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC3417406
- OpenAlex
- W2056453373
- Cited by
- 20
- References
- 43
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 7
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- CUNY Academic Works (City University of New York) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Columbia Academic Commons (Columbia University)
- Funders
- National Institutes of Health (n01hc25197-0-0-0)
- National Heart, Lung, and Blood Institute (HC25197, R24HL076857, K23HL004458, N01 HC025197, P01HL088117)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- depression, acute coronary syndrome, rumination, psychosocial vulnerability, dyadic adjustment, dysfunctional attitudes, role transition, life events, depressive symptoms, depression maintenance, interaction effects
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