Heart Failure Diagnosis Increases Risk for Suicide and Depression

A diagnosis of heart failure (HF) significantly increases the risk for new-onset depression and suicide in men and women, with the highest risk occurring within 3 months of a HF diagnosis, according to study findings published in Journal of the American College of Cardiology: Heart Failure.

Researchers conducted a national cohort study in Sweden that comprised 154,572 patients (mean age, 64.9±8.7 years; range, 18-75 years) diagnosed with HF from 2002 through 2017. Major depression and suicide were determined through follow-up (mean follow-up time, 13.8±4.5 years) from nationwide outpatient, inpatient, and death records through 2018. They also included more than 1,500,000 sex- and age-matched population-based control individuals. Poisson regression adjusted for comorbidities and sociodemographic factors was used to determine incidence rate ratios (IRRs).

The primary endpoints were first-ever diagnosis of major depression (identified by ICD-10 codes) and death by suicide (identified from the Swedish Cause of Death Register). Because previous studies suggested many suicides are misclassified as deaths with undetermined intent, the current study included intentional deaths and deaths of undetermined intent in the primary analysis and separately in the sensitivity analysis. Secondary endpoints included determining sex-specific differences and identifying susceptible time periods.

Researchers observed 138,002 cases of first-onset major depression and 3497 deaths by suicide. Across the follow-up period, 13.2% of HF patients without prior depression were diagnosed with new-onset major depression compared with 9.7% of control individuals. Cumulative incidences of new-onset major depression in men with HF were 11.7% vs 8.7% for controls and 18.5% in women with HF vs 15.8% for controls.

A total of 0.3% of patients with HF died by suicide compared with 0.2% of controls.

Researchers also found HF was associated with increased risk for major depression and death by suicide in both men and women. Men represented nearly 65% of all HF cases, of which nearly 60% were individuals aged 65 to 74 years. The highest risk was in the 3 months immediately following HF diagnosis, which declined to modest risk at 12 months or more following diagnosis. In the 3-month high-risk period, new-onset major depression in men (IRR, 3.34; 95% CI, 3.04-3.68) and in women (IRR, 2.78; 95% CI, 2.51-3.09) was observed.

Suicide rates were higher for men (IRR, 4.47; 95% CI, 2.62-7.62) than for women (IRR, 2.82; 95% CI, 1.11-7.12) within 3 months of HF diagnosis. All risks were elevated regardless of age at HF diagnosis. Women had disproportionally more cases of depression associated with HF (P <.001), and suicide death rates were higher among men.

Limitations of the study include lack of data on HF subtypes or severity, unvalidated major depression diagnoses, the exclusion of depression that was never diagnosed, and misclassification of suicide.

Study authors concluded, “[N]ewly diagnosed HF was associated with increased relative risks of new-onset major depression and suicide in men and women of all ages, with highest risks occurring in the first 3 months after HF diagnosis.” They added, “HF was associated with more depression cases in women than in men.”