Systematic Review and Individual Patient Data Meta-Analysis of Sex Differences in Depression and Prognosis in Persons With Myocardial Infarction: A MINDMAPS Study

Frank Doyle*, Hannah Mcgee, Ronn Conroy, Henk Jan Conradi, Anna Meijer, Richard Steeds, Hiroshi Sato, Donna E. Stewart, Kapil Parakh, Robert Carney, Kenneth Freedland, Matteo Anselmino, Roxanne Pelletier, Elisabeth H. Bos, Peter de Jonge

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

68 Citations (Scopus)


Objective: Using combined individual patient data from prospective studies, we explored sex differences in depression and prognosis post-myocardial infarction (MI) and determined whether disease indices could account for found differences.

Methods: Individual patient data analysis of 10,175 MI patients who completed diagnostic interviews or depression questionnaires from 16 prospective studies from the MINDMAPS study was conducted. Multilevel logistic and Cox regression models were used to determine sex differences in prevalence of depression and sex-specific effects of depression on subsequent outcomes.

Results: Combined interview and questionnaire data from observational studies showed that 36% (635/1760) of women and 29% (1575/5526) of men reported elevated levels of depression (age-adjusted odds ratio = 0.68, 95% confidence interval [CI] = 0.60-0.77). The risk for all-cause mortality associated with depression was higher in men (hazard ratio = 1.38, 95% CI = 1.30-1.47) than in women (hazard ratio = 1.22, 95% CI = 1.14-1.31; sex by depression interaction: p <.001). Low left ventricular ejection fraction (LVEF) was associated with higher depression scores in men only (sex by LVEF interaction: B = 0.294, 95% CI = 0.090-0.498), which attenuated the sex difference in the association between depression and prognosis.

Conclusions: The prevalence of depression post-MI was higher in women than in men, but the association between depression and cardiac prognosis was worse for men. LVEF was associated with depression in men only and accounted for the increased risk of all-cause mortality in depressed men versus women, suggesting that depression in men post-MI may, in part, reflect cardiovascular disease severity.

Original languageEnglish
Pages (from-to)419-428
Number of pages10
JournalPsychosomatic Medicine
Issue number4
Publication statusPublished - May-2015


  • depression
  • myocardial infarction
  • gender differences
  • prognosis
  • individual patient data meta-analysis

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