The forest through the trees. Investigating depression in patients with cancer and patients with myocardial infarction using systematic reviews and meta-analytic techniques

PhD ceremony: Ms. A. Meijer, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: The forest through the trees. Investigating depression in patients with cancer and patients with myocardial infarction using systematic reviews and meta-analytic techniques

Promotor(s): prof. P. de Jonge

Faculty: Medical Sciences

Depression is higher prevalent among people with a medical condition than among people in the general population. Depressed patients experience a lower quality of life, and depression is associated with worsened disease outcomes. In this thesis, the results of current research into depression in patients with cancer and in patients after a heart attack were investigated by means of literature studies.

In patients with cancer, a major question is whether these patients benefit from routine screening for depression, which has been recommended by a number of important institutions. This thesis concludes that there is not enough evidence to recommend routine screening for depression. The main issue is that there are too few high-quality studies investigating screening, so there is no scientific support for routine screening. Potentially, patients may benefit more from improved depression treatment than from screening alone.

In patients after a heart attack, depression is associated with worsened cardiac outcomes. The results of several studies across the world were combined and re-analyzed. Patients suffering from depression after their heart attack, have a 2 to 3 times increased risk of, for example, a new heart attack or death than patients without depression. Part of this association can be explained by the fact that depressed patients often also have more severe cardiac disease. More research is needed to investigate why depression is dangerous in patients after a heart attack, and whether improved treatment of depression also results in improved cardiac outcomes.