Association of Depression and Health Anxiety with 5-Year Mortality in Patients with ST-Elevation Myocardial Infarction: SEMI-CI study

BACKGROUND ST-elevation myocardial infarction (STEMI) is a leading cause of cardiovascular death worldwide. While acute treatment has improved, long-term outcomes are affected by non-biological factors like depression and health anxiety. Evidence from middle-income countries is limited. This study examines the link between baseline depression, health anxiety, and five-year mortality in STEMI patients. METHODS This secondary analysis utilized data from the fifth-year follow-up of the SEMI-CI cohort study, conducted in Isfahan, Iran. Patients with STEMI admitted between October 2015 and October 2016 to university-affiliated hospitals were followed for five years. Baseline psychological assessments included the PHQ-9 for depression and the Diagnostic Criteria for Psychosomatic Research (DCPR) for health anxiety. Patients with incomplete data or lost to follow-up were excluded. Five-year mortality was the primary outcome. Associations between psychological factors and mortality were analyzed using Chi-square and independent t-tests. RESULTS Out of 759 participants, 189 (24.9%) died due to cardiovascular causes over 5 years. Mortality was significantly associated with older age, female sex, diabetes, hypertension, reduced ejection fraction, anterior MI, and higher Killip class. Depression and health anxiety were more prevalent among deceased patients. In fully adjusted models, depression (HR: 2.23, 95% CI: 1.35–3.64) and health anxiety (HR: 1.11, 95% CI: 1.04–1.19) independently predicted cardiovascular mortality. CONCLUSION Depression and health anxiety influence five-year mortality in STEMI patients. Health anxiety is moderately associated with mortality and linked to higher smoking rates and increased depression. Depression shows a strong association with mortality, smoking, and hypercholesterolemia. These findings emphasize the critical need to incorporate psychological assessment and management into the long-term care of STEMI patients.