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. 2023 Feb 28;13(5):915.
doi: 10.3390/diagnostics13050915.

Psychopathology, Personality and Depression after Acute Coronary Syndrome: A Network Analysis in an Italian Population

Federica Folesani  1 , Lorenzo Luviè  2 , Cristina Palazzi  2 , Carlo Marchesi  2   3 , Rodolfo Rossi  4   5 , Martino Belvederi Murri  1 , Paolo Ossola  2   3
Affiliations

Psychopathology, Personality and Depression after Acute Coronary Syndrome: A Network Analysis in an Italian Population

Federica Folesani et al. Diagnostics (Basel). .

Abstract

Several biopsychosocial factors are associated with the onset of a Major Depressive Episode (MDE) after cardiovascular events. However, little is known of the interaction between trait- and state-like symptoms and characteristics and their role in predisposing cardiac patients to MDEs. Three hundred and four subjects were selected among patients admitted for the first time at a Coronary Intensive Care Unit. Assessment comprised personality features, psychiatric symptoms and general psychological distress; the occurrences of MDEs and Major Adverse Cardiovascular Events (MACE) were recorded during a two-year follow-up period. Network analyses of state-like symptoms and trait-like features were compared between patients with and without MDEs and MACE during follow-up. Individuals with and without MDEs differed in sociodemographic characteristics and baseline depressive symptoms. Network comparison revealed significant differences in personality features, not state-like symptoms: the group with MDEs displayed greater Type D personality traits and alexithymia as well as stronger associations between alexithymia and negative affectivity (edge differences between negative affectivity and difficulty identifying feelings was 0.303, and difficulty describing feelings was 0.439). The vulnerability to depression in cardiac patients is associated with personality features but not with state-like symptoms. Personality evaluation at the first cardiac event may help identify individuals more vulnerable to development of an MDE, and they could be referred to specialist care in order to reduce their risk.

Keywords: acute coronary syndrome; depression; network analysis; personality; risk factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Network of symptoms with Bayesian estimation and walktrap community detection in the subgroups with and without MDE at 24 months. 1: Depression; 2: Somatic; 3: Agitation; 4: Anxiety. Each node corresponds to a symptom cluster identified in the previous symptom reduction. Nodes are connected with lines (edges) that represent the strength of association between nodes. Green edges suggest a positive association, whereas red edges suggest a negative association. The thickness of the edge represents the edge’s weight, which is an indication of the strength of the association. The thicker the edge, the greater the weight and the stronger the association. In this network, all edges connecting the nodes are green (positive correlation), with their width indicating the strength of their connections. Node colors indicate the community of the nodes. In the MDE YES network: pink for agitation and somatic symptoms and grey for depression and anxiety. In the MDE NO network: pink for agitation and grey for depression, anxiety and somatic symptoms.
Figure 2
Figure 2
Network of trait measures with Bayesian estimation and walktrap community detection in the subgroups with and without MDE at 24 months. 1: TAS-20 Difficulty identifying feelings; 2: TAS-20 Difficulty describing feelings; 3: TAS-20 Externally oriented thinking; 4: TCI Novelty-seeking; 5: TCI Harm avoidance; 6: TCI Reward dependence; 7: TCI Self-directedness; 8: TCI Cooperativeness; 9: TCI Self-transcendence; 10: DS-14 Negative affectivity; 11: DS-14 Social inhibition; 12: DSQ-40 Mature defenses; 13: DSQ-40 Neurotic defenses; 14: DSQ-40 Immature defenses. Each node corresponds to a symptom cluster identified in the previous symptom reduction. Nodes are connected with lines (edges) that represent the strength of association between nodes. Green edges suggest a positive association, whereas red edges suggest a negative association. The thickness of the edge represents the edge’s weight, which is an indication of the strength of the association. The thicker the edge, the greater the weight and the stronger the association. In this network, all edges connecting the nodes are green (positive correlation), with their width indicating the strength of their connections. Node colors indicate the community of the nodes. In the MDE YES network: grey for inhibition, green for immature defenses, pink for TCI Characters, light blue for reward dependence and mature defenses and aquamarine for novelty-seeking. In the MDE NO network: pink for novelty-seeking and self-transcendence, grey for the TAS, green for harm avoidance and mature defenses, purple for immature defenses, light blue for TCI Reward dependence and characters and aquamarine for DS-14.
Figure 3
Figure 3
Differences of personality networks between those with and without MDE at follow-up. 1: TAS-20 Difficulty identifying feelings; 2: TAS-20 Difficulty describing feelings; 3: TAS-20 Externally oriented thinking; 4: TCI Novelty-seeking; 5: TCI Harm avoidance; 6: TCI Reward dependence; 7: TCI Self-directedness; 8: TCI Cooperativeness; 9: TCI Self-transcendence; 10: DS-14 Negative affectivity; 11: DS-14 Social inhibition; 12: DSQ-40 Mature defenses; 13: DSQ-40 Neurotic defenses; 14: DSQ-40 Immature defenses. Each node corresponds to a trait-like feature. The edges connecting the nodes indicate the main edge differences between the network of those with MDE and those without MDE, with green edges indicating positive differences and red edges indicating negative differences.
Figure 4
Figure 4
Network of symptoms with Bayesian estimation and walktrap community detection in the subgroups with and without MACE at 24 months. 1: Depression; 2: Somatic; 3: Agitation; 4: Anxiety. Each node corresponds to a symptom cluster identified in the previous symptom reduction. Nodes are connected with lines (edges) that represent the strengths of associations between nodes. Green edges suggest positive associations, whereas red edges suggest negative associations. The thickness of the edge represents the edge’s weight, which is an indication of the strength of the association. The thicker the edge, the greater the weight and the stronger the association. In this network, all edges connecting the nodes are green (positive correlation), and their widths indicate the strength of their connections. Node colors indicate the community of the nodes. In the MACE YES network, three communities were identified: somatic symptoms, depression and anxiety, and agitation. In the MACE NO network, two communities were identified: pink for agitation, and grey for somatic symptoms, depression and anxiety. All edges connecting the nodes are green (positive correlation), and their widths indicate the strength of their connections.
Figure 5
Figure 5
Network of trait measures with Bayesian estimation and walktrap community detection in the subgroups with and without MACE at follow-up. 1: TAS-20 Difficulty identifying feelings; 2: TAS-20 Difficulty describing feelings; 3: TAS-20 Externally oriented thinking; 4: TCI Novelty-seeking; 5: TCI Harm avoidance; 6: TCI Reward dependence; 7: TCI Self-directedness; 8: TCI Cooperativeness; 9: TCI Self-transcendence; 10: DS-14 Negative affectivity; 11: DS-14 Social inhibition; 12: DSQ-40 Mature defenses; 13: DSQ-40 Neurotic defenses; 14: DSQ-40 Immature defenses. Each node corresponds to a symptom cluster identified in the previous symptom reduction. Nodes are connected with lines (edges) that represent the strength of association between nodes. Green edges suggest positive associations, whereas red edges suggest negative associations. The thickness of the edge represents the edge’s weight, which is an indication of the strength of the association. The thicker the edge, the greater the weight and the stronger the association. In this network, all edges connecting the nodes are green (positive correlation), and their widths indicate the strength of their connections. Node colors indicate the community of the nodes. In the MACE YES network: grey for TCI characters, TAS DDF and TAS EOT; pink for immature defenses, harm avoidance and reward dependence and the DS-14; green for mature defenses and novelty-seeking; light blue for TAS DIF. In the MACE NO network: pink for defenses and the TCI Self-transcendence; green for the TAS; grey for the TCI personality traits and the DS-14.
Figure 6
Figure 6
Graphical representation of edge differences in the trait-like features network with Bayesian estimation between those with and without MACE at follow-up. 1: TAS-20 Difficulty identifying feelings; 2: TAS-20 Difficulty describing feelings; 3: TAS-20 Externally oriented thinking; 4: TCI Novelty-seeking; 5: TCI Harm avoidance; 6: TCI Reward dependence; 7: TCI Self-directedness; 8: TCI Cooperativeness; 9: TCI Self-transcendence; 10: DS-14 Negative affectivity; 11: DS-14 Social inhibition; 12: DSQ-40 Mature defenses; 13: DSQ-40 Neurotic defenses; 14: DSQ-40 Immature defenses. Each node corresponds to a trait-like feature. The edges connecting the nodes indicate the main edge differences between the network of those with MACE and those without MACE. All edges are red, indicating negative differences.
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