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PAPERS: C. M. DICKENS, L. McGOWAN, C. PERCIVAL, B. TOMENSON, L. COTTER, A. HEAGERTY, and F. H. CREED Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction The British Journal of Psychiatry 2006; 189: 367-372 [Abstract] [Full text] [PDF]

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CONCLUSION OR HYPOTHESIS

AMIT MALIK, Kusumma Madith   (1 February 2007)

CONCLUSION OR HYPOTHESIS 1 February 2007
AMIT MALIK, Senior House Officer , Kusumma Madith Send letter to journal: Re: CONCLUSION OR HYPOTHESIS amitmalik07{at}hotmail.com AMIT MALIK, et al.	We read the Dickens et al paper with great interest. The authors have clarified that this was an observational study and participants did not receive antidepressants. People with severe mental illness were excluded from the study. We felt that a proportion of the participants would be in need of antidepressants. The paper does not mention if antidepressants were commenced or not by the treating physicians (not researchers). The above point is quite important from ethical point of view. If some were put on the antidepressants how this group was treated by the researchers for the purpose of this study. The use of scales in the immediate post Myocardial infarction as baseline (average 3.6 days after admission) might not be very appropriate as patients were physically unwell. Poor physical health might color their views about mental health in the week preceding the infarct. The authors have used baseline scores to arrive at important conclusions. They have found that depression and anxiety that preceded myocardial infarction did not predict impairment in HRQoL 12 months following infarction. The hypothesis in the study that depression and anxiety contribute to impaired health related quality of life following myocardial infarction appears quite true on face value. We feel that quantifying this contribution as authors attempted to do is quite difficult as the scales used to measure quality of life are highly subjective. The authors using multiple regression statistics are able to demonstrate that depression and anxiety following myocardial infarction predict impairment in HRQoL 12 months following infarction. It would be a reasonable assumption, as authors’ state, that detection and treatment of depression and anxiety in the post MI period will improve health related quality of life. However in the brief summary of the paper at the beginning, the conclusion appears to suggest that detection and treatment of depression and anxiety in the post MI period will improve health related quality of life. This is an indirect inference from the findings of the study. It appears more as hypothesis rather than conclusion, which needs to be proved in a robust clinical trial.