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April 13, 1994

Depression and Survival Following Myocardial Infarction

JAMA. 1994;271(14):1080-1081. doi:10.1001/jama.1994.03510380036028

To the Editor.  —The study on depression and MI contains important new data.1 However, I have two concerns.First of all, by choosing to dichotomize variables, the authors lost important information. Ejection fraction should have been considered as a continuous variable, and more levels of smoking, Killip class, and education should have been used. The authors' argument would be strengthened by repeating their analysis using ejection fraction as a continuous variable.The treating physicians were not made aware of the diagnosis of depression. The "Methods" section states that the data were not analyzed until 3 months after the last patient was admitted to the study. "Thus, blinding researchers and clinicians to the DIS [National Institute of Mental Health Diagnostic Interview Schedule] results did not constitute an ethical problem." Failure to analyze the data is insufficient justification for withholding potentially important information (as the authors point out, depression is frequently