Depression, health anxiety, and five-year mortality after ST-elevation myocardial infarction: the SEMI-CI cohort

Abstract

Background: Psychological factors influence prognosis after ST-elevation myocardial infarction (STEMI), yet the long-term prognostic role of depression and health anxiety remains incompletely defined. We investigated whether these factors identify patients at increased mortality risk following STEMI. Methods: This secondary analysis included 759 patients from the SEMI-CI cohort, admitted between October 2015 and October 2016 and followed for five years. Depression was assessed at baseline using the Patient Health Questionnaire-9 (PHQ-9), and health anxiety was measured using four items from the Diagnostic Criteria for Psychosomatic Research (DCPR). The primary outcome was cardiovascular mortality. Associations were evaluated using Cox proportional hazards models adjusting for demographic, clinical, and cardiovascular risk factors. Health anxiety was treated as an exploratory predictor given limited measurement validity. Sensitivity analyses accounted for available covariates. Results: Among 759 participants, 189 (24.9) died from cardiovascular causes over five years. Mortality was higher among patients with depression (60/189, 31.7) compared to those without depression (115/570, 20.2). Health anxiety was present in 42 patients (all of them also had depression), 18 (42.9) of whom died. In fully adjusted Cox models, compared to patients with neither condition, mortality risk was significantly higher in those with only depression (HR 2.45, 95 CI 1.84-3.03) and those with concurrent depression and health anxiety (HR 2.11, 95 CI 0.11-4.09). Conclusions: In this cohort of STEMI patients, baseline depression was strongly associated with higher five-year cardiovascular mortality, while health anxiety showed a moderate association. These findings highlight the importance of assessing psychological factors as part of post-MI risk stratification, without implying causal relationships.