Heterogeneity of Patients With Coronary Artery Disease and Distress and the Need to Identify Relevant Subtypes—Reply

In reply

Drs de Jonge and Ormel believe that we should have discussed the importance of first vs recurrent depression, cognitive vs somatic symptoms of depression, and the persistence of symptoms, all topics on which they have written articles. Instead, we reported the data for the primary aims of our study: to determine the relative prognostic importance of the diagnostic categories of MDD and GAD using the best available standardized clinical interview (Structured Clinical Interview for DSM-IV) and to compare the prognostic importance of self-reports of symptom levels with the diagnostic categories. In doing so, we sought to expand and attempt to replicate our previous work that suggested that elevated depression symptoms after an MI are associated with as great a prognostic risk as the diagnosis of major depression.¹ Unlike most previous studies, including those cited by de Jonge and Ormel, in which patient assessments were made during a hospital admission for an acute MI, the current study sample was patients with CAD whose most recent admission had been at least 2 months earlier. We found that almost all of the risk associated with elevated depression and anxiety symptoms in these patients was accounted for by those meeting DSM-IV criteria and that the risks associated with MDD and GAD were equivalent. We feel that this is an important addition to the literature on heart disease and depression because it eliminated the noise created by short-term reactions to the crisis of hospitalization in which anxiety levels are often transiently high, provided data on the type of patient seen most often in the community, and is clinically useful because of the careful application of accepted psychiatric diagnostic criteria.