***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Whether there is an association between depression at the time of acute myocardial infa rct ion and subsequent risk of cardiac complications and death remains controversial . Most studies of this risk factor have been limited to patients of single institutions , and this might account for the varying results . We prospect ively evaluated patients admitted to 5 tertiary care and 5 community hospitals and followed them for 1 year to measure the prevalence and prognostic impact of depressive symptoms after acute myocardial infa rct ion . METHODS Patients were recruited for the study by trained nurse interviewers who had documented acute myocardial infa rct ion within 2 - 3 days of admission . The nurses collected information from the medical records and asked study subjects to complete the  Beck Depression Inventory question naire during their stay in hospital and using a mailed question naire 30 days , 6 months and 1 year later . We obtained information on vital status for patients lost to follow-up from a central death registry . RESULTS Of the 587 study subjects , 550 ( 94 % ) completed the Beck Depression Inventory at baseline and 191 ( 35 % ) had a score of 10 or more , indicating at least mild depression . Rates of depression did not vary over the follow-up period and were similar among patients admitted to tertiary care or community hospitals . Depressed patients were more likely to undergo catheterization ( 57 % v. 47 % , 95 % confidence interval [ CI ] around the difference 0.1%-19.6 % ) and were more likely to undergo percutaneous coronary intervention ( 32 % v. 24 % , 95 % CI around the difference 0.1%-16.2 % ) within 30 days of first admission to hospital . Patients with depression on admission had higher rates of a composite of cardiac complications , including recurrent ischemia , infa rct ion or congestive heart failure during their first stay in hospital or readmission for angina , recurrent acute myocardial infa rct ion , congestive heart failure or arrhythmia ( adjusted hazard ratio 1.4 , 95 % CI 1.05 - 1.86 ) , compared with patients who were not depressed on admission . After 1 year , death rates were higher among patients who were depressed at admission ( 30 patients , 16 % ) compared with nondepressed patients ( 28 patients , 8 % ) , although the difference was not statistically significant ( hazard ratio 1.3 , 95 % CI 0.59 - 3.05 ) . INTERPRETATION Depressive symptoms are common after acute myocardial infa rct ion and are associated with a slight increase in risk of in-hospital catheterization and angiography and readmission because of cardiac complications . Death was infrequent , with no statistically significant difference between the 2 groups Background —Women have an unexplained worse outcome after myocardial infa rct ion ( MI ) compared with men in many studies . Depressive symptoms predict adverse post-MI outcomes and are more prevalent among women than men . We examined whether depressive symptoms contribute to women ’s worse outcomes after MI . Methods and Results —In a prospect i ve multicenter study ( PREMIER ) , 2411 ( 807 women ) MI patients were enrolled .  Depressive symptoms were assessed with the Patient Health Question naire .  Outcomes included 1-year rehospitalization , presence of angina using the Seattle Angina Question naire , and 2-year mortality . Multivariable analyses were used to evaluate the association between sex and these outcomes , adjusting for clinical characteristics . The depressive symptoms score was added to the models to evaluate whether it attenuated the association between sex and outcomes . Depressive symptoms were more prevalent in women compared with men ( 29 % versus 18.8 % , P<0.001 ) . After adjusting for demographic factors , comorbidities , and MI severity , women had a mildly higher risk of rehospitalization ( hazard ratio , 1.20 ; 95 % CI , 1.04 to 1.40 ) , angina ( odds ratio , 1.32 ; 95 % CI , 1.00 to 1.75 ) , and mortality ( hazard ratio , 1.27 ; 95 % CI , 0.98 to 1.64 ) . After adding depressive symptoms to the multivariable models , the relationship further declined toward the null , particularly for rehospitalization ( hazard ratio , 1.14 ; 95 % CI , 0.98 to 1.34 ) and angina ( odds ratio , 1.22 ; 95 % CI , 0.91 to 1.63 ) , whereas there was little change in the estimate for mortality ( hazard ratio , 1.24 ; 95 % CI , 0.95 to 1.62 ) . Depressive symptoms were significantly associated with each of the study outcomes with a similar magnitude of effect in both women and men . Conclusions —A higher prevalence of depressive symptoms in women modestly contributes to their higher rates of rehospitalization and angina compared with men but not mortality after MI . Our results support the recent recommendations of improving recognition of depressive symptoms after MI BACKGROUND Depression is associated with an increased risk for mortality after acute myocardial infa rct ion ( MI ) . The purpose of this study was to determine whether low heart rate variability ( HRV ) mediates the effect of depression on mortality . METHODS Twenty-four-hour ambulatory electrocardiograms were obtained from 311 depressed patients with a recent acute MI who were enrolled in the Enhancing Recovery in Coronary Heart Disease ( ENRICHD ) clinical trial and from 367 nondepressed patients who met the ENRICHD medical inclusion criteria .  St and ard HRV indexes were extracted from the recordings . RESULTS The log of very low-frequency ( LnVLF ) power , an index of HRV derived from power spectral analysis of the electrocardiogram signal ( 0.0033 - 0.04 Hz [ in milliseconds squared ] ) , was lower in the depressed than in the nondepressed patients ( P<.001 ) . There were 47 deaths ( 6.1 % ) during a 30-month follow-up . After adjusting for potential confounders , the depressed patients remained at higher risk for all-cause mortality compared with the nondepressed patients ( hazard ratio , 2.8 ; 95 % confidence interval [ CI ] , 1.4 - 5.4 ; P<.003 ) . When LnVLF power was entered into the model , the hazard ratio for depression dropped to 2.1 ( 95 % CI , 1.1 - 4.2 ; P = .03 ) . The proportion of the risk for depression attributable to LnVLF power was 0.27 ( 95 % CI , 0.23 - 0.31 ; P<.001 ) . CONCLUSIONS Low HRV partially mediates the effect of depression on survival after acute MI . This finding helps to clarify the physiological mechanisms underlying depression 's role as a risk factor for mortality in patients with coronary heart disease . It also raises the possibility that treatments that improve both depression and HRV might also improve survival in these patients Background — The American Heart Association ( AHA ) statement has recommended routine screening for depression in coronary artery disease with a 2-stage implementation of the Patient Health Question naire ( PHQ ) . Because there is little evidence on feasibility , accuracy , and impact of such a program on depression recognition in coronary patients , the AHA recommendation has met substantial debate and criticism . Methods and Results — Before the AHA statement was released , the Mid America Heart and Vascular Institute ( MAHVI ) had implemented a depression screening protocol for patients with acute myocardial infa rct ion that was virtually identical to the AHA recommendations . To ( 1 ) evaluate this MAHVI quality improvement initiative , ( 2 ) compare MAHVI depression recognition rates with those of other hospitals , and ( 3 ) examine health care providers ' implementation feedback , we compared the results of the MAHVI screening program with data from a parallel prospect i ve acute myocardial infa rct ion registry and interviewed MAHVI providers . Depressive symptoms ( PHQ-2 , PHQ-9 ) were assessed among 503 MAHVI acute myocardial infa rct ion patients and compared with concurrent depression assessment s among 3533 patients at 23 US centers without a screening protocol . A qualitative summary of providers ' suggestions for improvement was also generated . A total of 135 ( 26.8 % ) eligible MAHVI patients did not get screened . Among screened patients , 90.9 % depressed ( PHQ-9 ≥10 ) patients were recognized . The agreement between the screening and registry data using the full PHQ-9 was 61.5 % for positive cases ( PHQ-9 ≥10 ) but only 35.6 % for the PHQ-2 alone . Although MAHVI had a slightly higher overall depression recognition rate ( 38.3 % ) than other centers not using a depression screening protocol ( 31.5 % ) , the difference was not statistically significant ( P=0.31 ) . Staff feedback suggested that a single-stage screening protocol with continuous feedback could improve compliance . Conclusions — In this early effort to implement a depression screening protocol , a large proportion of patients did not get screened , and only a modest impact on depression recognition rates was realized . Simplifying the protocol by using the PHQ-9 alone and providing more support and feedback may improve the rates of depression detection and treatment CONTEXT Depression and low perceived social support ( LPSS ) after myocardial infa rct ion ( MI ) are associated with higher morbidity and mortality , but little is known about whether this excess risk can be reduced through treatment . OBJECTIVE To determine whether mortality and recurrent infa rct ion are reduced by treatment of depression and LPSS with cognitive behavior therapy ( CBT ) , supplemented with a selective serotonin reuptake inhibitor ( SSRI ) antidepressant when indicated , in patients enrolled within 28 days after MI . DESIGN , SETTING , AND PATIENTS R and omized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients ( 1084 women , 1397 men ) enrolled from 8 clinical centers . Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression ( HRSD ) ; LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients ( ENRICHD ) Social Support Instrument ( ESSI ) . R and om allocation was to usual medical care or CBT-based psychosocial intervention . INTERVENTION Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months , plus group therapy when feasible , with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50 % reduction in Beck Depression Inventory scores after 5 weeks . MAIN OUTCOME MEASURES Composite primary end point of death or recurrent MI ; secondary outcomes included change in HRSD ( for depression ) or ESSI scores ( for LPSS ) at 6 months . RESULTS Improvement in psychosocial outcomes at 6 months favored treatment : mean ( SD ) change in HRSD score , -10.1 ( 7.8 ) in the depression and psychosocial intervention group vs -8.4 ( 7.7 ) in the depression and usual care group ( P<.001 ) ; mean ( SD ) change in ESSI score , 5.1 ( 5.9 ) in the LPSS and psychosocial intervention group vs 3.4 ( 6.0 ) in the LPSS and usual care group ( P<.001 ) . After an average follow-up of 29 months , there was no significant difference in event-free survival between usual care ( 75.9 % ) and psychosocial intervention ( 75.8 % ) . There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups ( depression , LPSS , and depression and LPSS patients ) . CONCLUSIONS The intervention did not increase event-free survival . The intervention improved depression and social isolation , although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients BACKGROUND Depression predicts worse outcomes after myocardial infa rct ion ( MI ) , but whether its time course in the month following MI has prognostic importance is unknown . Our objective was to evaluate the prognostic importance of transient , new , or persistent depression on outcomes at 6 months after MI . METHODS In a prospect i ve registry of acute MI ( Prospect i ve Registry Evaluating outcomes after Myocardial Infa rct ion : Events and Recovery [ PREMIER ] ) , depressive symptoms were measured in 1873 patients with the Patient Health Question naire ( PHQ ) during hospitalization and 1 month after discharge and were classified as transient ( only at baseline ) , new ( only at 1 month ) , or persistent ( at both times ) . Outcomes at 6 months included ( 1 ) all-cause rehospitalization or mortality and ( 2 ) health status ( angina , physical limitation , and quality of life using the Seattle Angina Question naire ) . RESULTS Compared with nondepressed patients , all categories of depression were associated with higher rehospitalization or mortality rates , more frequent angina , more physical limitations , and worse quality of life . The adjusted hazard ratios for rehospitalization or mortality were 1.34 
    Output:
    
Despite limitations in some individual studies , our review identified generally consistent associations between depression and adverse outcomes .