Longitudinal trajectories of depression and lifestyle behaviours in acute coronary syndrome patients

Background: Cantiovascular diseases (CVD) are associated with a range of psychosocial factors; among these, depression has been the most investigated factor in recent years. Several studies have demonstrated the relationship between depression and the clinical progression of established CVDs. Indeed, patients' depressìon predicts different outcomes, such as recurrent cardiac events, but less is known about the impact on lifestyle behaviours. Moreover, to the best of our knowledge, no studies have explored the development trajectories of depression and lifestyle in Acute Coronary Syndrome (ACS). Purpose: The aim of this study, across two years in a cohort of patients newly diagnosed with ACS, was (1) to investigate the development of longitudinal trajectories of depression and lifestyle behaviours (in terms of diet, physical activity, and smoking), and (2) to identify unknown (i.e., latent) subgroups with distinct trajectories of depression, examining whether and how the latent subgroups identified differ in terms of lifestyle behaviour. Methods: A cohort of 275 patients newly diagnosed with ACS from three hospitals in northen Italy was recruited for this prospective study with four measurement points (baseline, 6-month, 12-month, and 24-month follow-ups). Questionnaires were administered by trained researchers for measuring depression and lifestyle behaviours. Also anamnestic and clinical data were collected. Latent growth curve modeling (LGCM) was used to determine the trajectories of depression and Iifestyle behaviours. Latent class growth analysis (LCGA) was conducted to explore discrete developmental subtypes of patients based on depression scores; furthermore, LGCM was used to explore the trajectories of these subgroups in terms of lifestyle behaviours. Results: Results of LGCM indicated that depression, diet, physical activity, and smoking behaviour show nonlinear growth trajectories, with a great improvement after the baseline and then a gradual decline for the rest of the observation period. Moreover, results of LGCA (Bayesian Information Criterion=4,640.0; Entropy=0.77) identified three course trajectories of depression (see fig. 1), ranging from no severity (class 1=45.7% of patients), to medium and fluctuating (class 2=37.0%), to chronic course trajectory (class 3=17.3%). This last class differed on diet, physical activities, and smoking behaviour from other classes, also controlling for socio-demographic characteristics and for clinical baseline functions. Conclusions: The nonlinear trajectory of depression and lifestyle observed across all patients provides insight for secondary prevention in relation to the dynamics of recovery in ACS. Moreover, our findings of three growth patterns in depression over time illustrate a potentially powerful methodological approach in clinical research suggesting that a typological approach could provide highly relevant information for clinical practice and interventions in CVDs.