Health Psychology has received numerous papers over the past several months on topics related to the COVID-19 pandemic. Many of them concern depression, anxiety, stress, or other forms of distress in the general population or in health care workers. We have received far fewer papers on COVID-related health behaviors and health communications-factors that have played central roles in the spread of the pandemic and that are major topics in health psychology. Our experience is consistent with the published scientific literature on the pandemic. A Medline search that we conducted in late September yielded over 23,000 English-language articles pertaining to COVID-19. Over 1,400 of them concerned topics that are within the scope of Health Psychology. As shown in Table 1, COVID-related mental disorders comprised the largest category. Many other studies concerned other forms of stress or emotional distress. At least 248 articles addressed the profound ethnic and racial disparities in COVID-19 infection and death rates and in access to health care that are accentuating longstanding health inequities; 22 (9%) of these articles addressed behavioral or psychosocial aspects of COVID-19 health disparities. Thus, the literature on the behavioral and psychosocial aspects of the pandemic has been dominated, so far at least, by research on stress or distress. Fewer reports have been published so far on critical COVID-related health behaviors, health communication, or health disparities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background

Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome.

Methods and results

Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes.

Conclusions

Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.