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April 13, 1994

Depression and Survival Following Myocardial Infarction-Reply

Author Affiliations

Duke University Durham, NC
University of California—San Francisco

JAMA. 1994;271(14):1082. doi:10.1001/jama.1994.03510380036032

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In Reply.  —Dr Cleophas is worried that behavioral interventions aimed at reducing the adverse impact of psychosocial factors in patients who had an MI would not do any good for the 84% who were not depressed. We remind him that none of the clinical trials of psychosocial interventions in either coronary heart disease or cancer that we cited in our Editorial had selected patients who were depressed; yet in each trial there was a favorable impact on prognosis. The psychosocial interventions used in these successful trials addressed not only the problems of depression but also aimed to reduce the impact of other harmful factors, such as social isolation and hostile, competitive, and impatient behavior, among heart disease victims. We cannot be sure what proportion of patients having an MI are placed at higher risk by these other characteristics. Nevertheless, it is surely a larger proportion than the 16% with major

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