Introduction/Objective: Although much is written about an association between psychiatric depression and cardiovascular morbidity and mortality, evaluation and treatment for depression post-myocardial infarction (MI) is not a standard component of care. This work is a critical appraisal of the literature which addresses the effect of psychiatric depression on cardiovascular prognosis, specifically on the rate of cardiac events and mortality after MI.

Methods: (1) Medline search (1987-97) for generic, prognosis and harm/etiology studies. Additional studies from bibliographies, communication with other researchers; (2) Relevancy criteria: study addressed question prospectively; specified inclusion criteria, measures of depression, mortality and complications; (3) Validity criteria: standard evidence-based criteria for appraisal of prognosis or harm/etiology studies, further refined for this topic.

Results: Search yielded 9 non-appraised reviews, 115 generic articles, 54 prognosis/etiology articles. 17 remained after relevancy assessment. 4 met validity criteria. All 4 showed an independent effect of depression on mortality and 2 on emergence of post-MI ventricular arrhythmia. 3/4 were studies of specialized populations. The effect size on mortality was small but significant. Variation between study methods and populations precluded meta-analysis.

Discussion: Corroborative studies of non-specialized populations, further work to elucidate the underlying mechanisms of this effect and to delineate which sub-populations may be at greatest added risk are needed. While it is increasingly claimed that untreated psychiatric comorbidity (such as depression) may play a significant prognostic role in medical illness, a critical appraisal of this literature is needed to define the boundaries of knowledge and guide further investigations into diagnosis, therapy and delivery of care.