Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Change in Depression as a Precursor of Cardiovascular Events

Change in Depression as a Precursor of Cardiovascular Events Abstract Objective: To determine the relationship between increasing depressive symptoms and cardiovascular events or mortality. Design: Cohort analytic study of data from randomized placebo-controlled double-blind clinical trial of antihypertensive therapy. Depressive symptoms were assessed semiannually with the Center for Epidemiological Studies— Depression (CES-D) scale during an average follow-up of 4.5 years. Setting: Ambulatory patients in 16 clinical centers of the Systolic Hypertension in the Elderly Program. Patients: Generally healthy men and women aged 60 years or older randomized to active antihypertensive drug therapy or placebo who were 79% white and 53% women and had follow-up CES-D scores and no outcome events during the first 6 months (N=4367). Main Outcome Measures: All-cause mortality, fatal or nonfatal stroke, or myocardial infarction. Results: Baseline depressive symptoms were not related to subsequent events; however, an increase in depression was prognostic. Cox proportional hazards regression analyses with the CES-D scale as a time-dependent variable, controlling for multiple covariates, indicated a 25% increased risk of death per 5-unit increase in the CES-D score (relative risk [RR], 1.25; 95% confidence interval [CI], 1.15 to 1.36). The RR for stroke or myocardial infarction was 1.18 (95% CI, 1.08 to 1.30). Increase in CES-D score was an independent predictor in both placebo and active drug groups, and it was strongest as a risk factor for stroke among women (RR, 1.29; 95% CI, 1.07 to 1.34). Conclusions: Among elderly persons, a significant and substantial excess risk of death and stroke or myocardial infarction was associated with an increase in depressive symptoms over time, which may be a marker for subsequent major disease events and warrants the attention of physicians to such mood changes. However, further studies of causal pathways are needed before widespread screening for depression in clinical practice is to be recommended.(Arch Intern Med. 1996;156:553-561) References 1. Fielding R. Depression and acute myocardial infarction: a review and reinterpretation . Soc Sci Med. 1991;32:1017-1027.Crossref 2. Dalack GW, Roose SP. Perspectives on the relationship between cardiovascular disease and affective disorder . J Clin Psychiatry. 1990;51( (suppl) ):7. 3. Berkman LS, Berkman CS, Kasl S, et al. Depressive symptoms in relation to physical health and functioning in the elderly . Am J Epidemiol. 1986;124:372-388. 4. Gatz M, Hurwicz ML. Are old people more depressed? cross-sectional data on Center for Epidemiological Studies Depression Scale factors . Psychol Aging. 1990;5:284-290.Crossref 5. Kaplan GA, Roberts RE, Camacho TC, Coyne JC. Psychosocial predictors of depression . Am J Epidemiol. 1987;125:206-220. 6. Blazer D, Burchett B, Service C, George LK. The association of age and depression among the elderly: an epidemiologic exploration . J Gerontol. 1991; 46:M210-M215.Crossref 7. Kennedy GJ, Fisher JD. Aging, stress, and cardiac death . Mt Sinai J Med. 1987; 51:56-62. 8. Carney RM, Freedland KE, Jaffe AS. Insomnia and depression prior to myocardial infarction . Psychosom Med. 1990;52:603-609.Crossref 9. Appels A. Mental precursors of myocardial infarction . Br J Psychiatry. 1990; 156:465-471.Crossref 10. Thomas C, Kelman HR, Kennedy GJ, Ahn C, Yang C. Depressive symptoms and mortality in elderly persons . J Gerontol. 1992;47( (suppl 2) ):S80-S87.Crossref 11. The Systolic Hypertension in the Elderly Program (SHEP) Cooperative Research Group. Rationale and design of a randomized clinical trial on prevention of stroke in isolated systolic hypertension . J Clin Epidemiol. 1988;41:1197-1208.Crossref 12. The Systolic Hypertension in the Elderly Program (SHEP) Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension . JAMA. 1991;265:3255-3264.Crossref 13. Applegate WB, Pressel S, Wittes J, et al. Impact of the treatment of isolated systolic hypertension on behavioral variables: results from the Systolic Hypertension in the Elderly (SHEP) Study . Arch Intern Med. 1994;154:2154-2160.Crossref 14. Gurland B, Golden R, Challop J. Unidimensional and multidimensional approaches to the differentiation of depression and dementia in the elderly . In: Corkin S, Davis KL, Crowden J II, Usdin E, Wurtman RJ, eds. Alzheimer's Disease: A Report of Progress in Research . New York, NY: Raven Press; 1981. 15. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population . J Appl Psychol Meas. 1977;1:385-401.Crossref 16. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jafine NW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychological function . JAMA. 1963;815:94. 17. Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data . New York, NY: John Wiley & Sons Inc; 1980. 18. Kennedy GJ, Kelman HR, Thomas C. The emergence of depressive symptoms in late life: the importance of declining health and increasing disability . J Commun Health. 1990;15:93-104.Crossref 19. Comstock GW, Helsing KJ. Symptoms of depression in two communities . Psychol Med. 1976;6:551-563.Crossref 20. Murrell SA, Himmelfarb S, Wright K. Prevalence of depression and its correlates in older adults . Am J Epidemiol. 1983;117:173-185. 21. Bruce ML, Leaf PJ. Psychiatric disorders and 15-month mortality in a community sample of older adults . Am J Public Health. 1989;79:727-730.Crossref 22. Markush RE, Schwab JJ, Farris P, Present PA, Holzer CE. Mortality and community health . Arch Gen Psychiatry. 1977;34:1393-1401.Crossref 23. Enzell K. Mortality among persons with depressive symptoms and among responders and non-responders in a health check-up . Acta Psychiatr Scand. 1984;69:89-102.Crossref 24. Colantonio A, Kasl SV, Ostfeld AM, Berkman LF. Depressive symptoms and other psychosocial factors as predictors of stroke in the elderly . Am J Epidemiol. 1992;136:884-894.Crossref 25. Persson G. Five-year mortality in a 7-year-old population in relation to psychiatric diagnosis, personality, sexuality and family parental death . Acta Psychiatr Scand. 1981;64:244-253.Crossref 26. Fredman L, Schoenbach VJ, Kaplan BH, et al. The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey . J Gerontol. 1989;44( (suppl 4) ): S149-S156.Crossref 27. Crisp AH, Queenan M, D'Souza MF. Myocardial infarction and the emotional climate . Lancet. 1984;1:616-619.Crossref 28. Appels A, Mulder P. Excess fatigue as a precursor of myocardial infarction . Eur Heart J. 1988;9:758-764.Crossref 29. Appels A, Mulder P. Fatigue and heart disease: the association between 'vital exhaustion' and past, present and future coronary heart disease . J Psychosom Res. 1989;33:727-738.Crossref 30. Haft JI. Cardiovascular injury induced by sympathetic catecholamines . Prog Cardiovasc Dis. 1974;17:73-86.Crossref 31. Rahe RH, Rubin RT, Gunderson E, Arthur RJ. Psychologic correlates of serum cholesterol in man . Psychosom Med. 1971;33:399-410.Crossref 32. Van Doornen LJP, van Blokland RW. The relation of type A behavior and vital exhaustion with physiological reactions to real life stress . J Psychosom Res. 1989;33:715-725.Crossref 33. Pryce IG. Melancholia: glucose tolerance and body weight . J Ment Sci. 1958; 104:421-427. 34. Pryce IG. The relationship between glucose tolerance, body weight, and clinical state in melancholia . J Ment Sci. 1958;104:1079-1092. 35. Dole VP. A relation between non-esterified fatty acids in plasma and the metabolism of glucose . J Clin Invest. 1956;35:150-154.Crossref 36. Pryce IG. The relationship between 17-hydroxycorticosteroid excretion and glucose utilization in depressions . Br J Psychiatry. 1964;110:90-94.Crossref 37. Steptoe A, Melville D, Ross A. Behavioral response demands, cardiovascular reactivity, and essential hypertension . Psychosom Med. 1984;46:33-48.Crossref 38. Zyzanski SJ, Jenkins CD, Ryan TJ, Flessas A, Everist M. Psychological correlates of coronary angiographic findings . Arch Intern Med. 1976;136:1234-1237.Crossref 39. Hackett TP, Cassem NH, Wishnie HA. The coronary care unit: an appraisal of its psychologic hazards . N Engl J Med. 1973;279:1365-1370.Crossref 40. Dimsdale JE. Emotional causes of sudden death . Am J Psychiatry. 1977;134:1361-1366. 41. Little RA, Frayn KN, Randall PE, et al. Plasma catecholamines in patients with acute myocardial infarction and in cardiac arrest . Q J Med. 1985;54:133-140. 42. Verrier RL, Lown B. Behavioral stress and cardiac arrhythmias . Ann Rev Physiol. 1984;46:155-176.Crossref 43. US Dept of Health and Human Services. Detection and diagnosis . In: Depression in Primary Care . Washington, DC: US Dept of Health and Human Services; 1993;1. 44. US Dept of Health and Human Services. Treatment of major depression . In: Depression in Primary Care . Washington, DC: US Dept of Health and Human Services; 1993;2. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Loading next page...
 
/lp/american-medical-association/change-in-depression-as-a-precursor-of-cardiovascular-events-qkwRqhC6Dz

References (48)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1996.00440050111012
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine the relationship between increasing depressive symptoms and cardiovascular events or mortality. Design: Cohort analytic study of data from randomized placebo-controlled double-blind clinical trial of antihypertensive therapy. Depressive symptoms were assessed semiannually with the Center for Epidemiological Studies— Depression (CES-D) scale during an average follow-up of 4.5 years. Setting: Ambulatory patients in 16 clinical centers of the Systolic Hypertension in the Elderly Program. Patients: Generally healthy men and women aged 60 years or older randomized to active antihypertensive drug therapy or placebo who were 79% white and 53% women and had follow-up CES-D scores and no outcome events during the first 6 months (N=4367). Main Outcome Measures: All-cause mortality, fatal or nonfatal stroke, or myocardial infarction. Results: Baseline depressive symptoms were not related to subsequent events; however, an increase in depression was prognostic. Cox proportional hazards regression analyses with the CES-D scale as a time-dependent variable, controlling for multiple covariates, indicated a 25% increased risk of death per 5-unit increase in the CES-D score (relative risk [RR], 1.25; 95% confidence interval [CI], 1.15 to 1.36). The RR for stroke or myocardial infarction was 1.18 (95% CI, 1.08 to 1.30). Increase in CES-D score was an independent predictor in both placebo and active drug groups, and it was strongest as a risk factor for stroke among women (RR, 1.29; 95% CI, 1.07 to 1.34). Conclusions: Among elderly persons, a significant and substantial excess risk of death and stroke or myocardial infarction was associated with an increase in depressive symptoms over time, which may be a marker for subsequent major disease events and warrants the attention of physicians to such mood changes. However, further studies of causal pathways are needed before widespread screening for depression in clinical practice is to be recommended.(Arch Intern Med. 1996;156:553-561) References 1. Fielding R. Depression and acute myocardial infarction: a review and reinterpretation . Soc Sci Med. 1991;32:1017-1027.Crossref 2. Dalack GW, Roose SP. Perspectives on the relationship between cardiovascular disease and affective disorder . J Clin Psychiatry. 1990;51( (suppl) ):7. 3. Berkman LS, Berkman CS, Kasl S, et al. Depressive symptoms in relation to physical health and functioning in the elderly . Am J Epidemiol. 1986;124:372-388. 4. Gatz M, Hurwicz ML. Are old people more depressed? cross-sectional data on Center for Epidemiological Studies Depression Scale factors . Psychol Aging. 1990;5:284-290.Crossref 5. Kaplan GA, Roberts RE, Camacho TC, Coyne JC. Psychosocial predictors of depression . Am J Epidemiol. 1987;125:206-220. 6. Blazer D, Burchett B, Service C, George LK. The association of age and depression among the elderly: an epidemiologic exploration . J Gerontol. 1991; 46:M210-M215.Crossref 7. Kennedy GJ, Fisher JD. Aging, stress, and cardiac death . Mt Sinai J Med. 1987; 51:56-62. 8. Carney RM, Freedland KE, Jaffe AS. Insomnia and depression prior to myocardial infarction . Psychosom Med. 1990;52:603-609.Crossref 9. Appels A. Mental precursors of myocardial infarction . Br J Psychiatry. 1990; 156:465-471.Crossref 10. Thomas C, Kelman HR, Kennedy GJ, Ahn C, Yang C. Depressive symptoms and mortality in elderly persons . J Gerontol. 1992;47( (suppl 2) ):S80-S87.Crossref 11. The Systolic Hypertension in the Elderly Program (SHEP) Cooperative Research Group. Rationale and design of a randomized clinical trial on prevention of stroke in isolated systolic hypertension . J Clin Epidemiol. 1988;41:1197-1208.Crossref 12. The Systolic Hypertension in the Elderly Program (SHEP) Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension . JAMA. 1991;265:3255-3264.Crossref 13. Applegate WB, Pressel S, Wittes J, et al. Impact of the treatment of isolated systolic hypertension on behavioral variables: results from the Systolic Hypertension in the Elderly (SHEP) Study . Arch Intern Med. 1994;154:2154-2160.Crossref 14. Gurland B, Golden R, Challop J. Unidimensional and multidimensional approaches to the differentiation of depression and dementia in the elderly . In: Corkin S, Davis KL, Crowden J II, Usdin E, Wurtman RJ, eds. Alzheimer's Disease: A Report of Progress in Research . New York, NY: Raven Press; 1981. 15. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population . J Appl Psychol Meas. 1977;1:385-401.Crossref 16. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jafine NW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychological function . JAMA. 1963;815:94. 17. Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data . New York, NY: John Wiley & Sons Inc; 1980. 18. Kennedy GJ, Kelman HR, Thomas C. The emergence of depressive symptoms in late life: the importance of declining health and increasing disability . J Commun Health. 1990;15:93-104.Crossref 19. Comstock GW, Helsing KJ. Symptoms of depression in two communities . Psychol Med. 1976;6:551-563.Crossref 20. Murrell SA, Himmelfarb S, Wright K. Prevalence of depression and its correlates in older adults . Am J Epidemiol. 1983;117:173-185. 21. Bruce ML, Leaf PJ. Psychiatric disorders and 15-month mortality in a community sample of older adults . Am J Public Health. 1989;79:727-730.Crossref 22. Markush RE, Schwab JJ, Farris P, Present PA, Holzer CE. Mortality and community health . Arch Gen Psychiatry. 1977;34:1393-1401.Crossref 23. Enzell K. Mortality among persons with depressive symptoms and among responders and non-responders in a health check-up . Acta Psychiatr Scand. 1984;69:89-102.Crossref 24. Colantonio A, Kasl SV, Ostfeld AM, Berkman LF. Depressive symptoms and other psychosocial factors as predictors of stroke in the elderly . Am J Epidemiol. 1992;136:884-894.Crossref 25. Persson G. Five-year mortality in a 7-year-old population in relation to psychiatric diagnosis, personality, sexuality and family parental death . Acta Psychiatr Scand. 1981;64:244-253.Crossref 26. Fredman L, Schoenbach VJ, Kaplan BH, et al. The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey . J Gerontol. 1989;44( (suppl 4) ): S149-S156.Crossref 27. Crisp AH, Queenan M, D'Souza MF. Myocardial infarction and the emotional climate . Lancet. 1984;1:616-619.Crossref 28. Appels A, Mulder P. Excess fatigue as a precursor of myocardial infarction . Eur Heart J. 1988;9:758-764.Crossref 29. Appels A, Mulder P. Fatigue and heart disease: the association between 'vital exhaustion' and past, present and future coronary heart disease . J Psychosom Res. 1989;33:727-738.Crossref 30. Haft JI. Cardiovascular injury induced by sympathetic catecholamines . Prog Cardiovasc Dis. 1974;17:73-86.Crossref 31. Rahe RH, Rubin RT, Gunderson E, Arthur RJ. Psychologic correlates of serum cholesterol in man . Psychosom Med. 1971;33:399-410.Crossref 32. Van Doornen LJP, van Blokland RW. The relation of type A behavior and vital exhaustion with physiological reactions to real life stress . J Psychosom Res. 1989;33:715-725.Crossref 33. Pryce IG. Melancholia: glucose tolerance and body weight . J Ment Sci. 1958; 104:421-427. 34. Pryce IG. The relationship between glucose tolerance, body weight, and clinical state in melancholia . J Ment Sci. 1958;104:1079-1092. 35. Dole VP. A relation between non-esterified fatty acids in plasma and the metabolism of glucose . J Clin Invest. 1956;35:150-154.Crossref 36. Pryce IG. The relationship between 17-hydroxycorticosteroid excretion and glucose utilization in depressions . Br J Psychiatry. 1964;110:90-94.Crossref 37. Steptoe A, Melville D, Ross A. Behavioral response demands, cardiovascular reactivity, and essential hypertension . Psychosom Med. 1984;46:33-48.Crossref 38. Zyzanski SJ, Jenkins CD, Ryan TJ, Flessas A, Everist M. Psychological correlates of coronary angiographic findings . Arch Intern Med. 1976;136:1234-1237.Crossref 39. Hackett TP, Cassem NH, Wishnie HA. The coronary care unit: an appraisal of its psychologic hazards . N Engl J Med. 1973;279:1365-1370.Crossref 40. Dimsdale JE. Emotional causes of sudden death . Am J Psychiatry. 1977;134:1361-1366. 41. Little RA, Frayn KN, Randall PE, et al. Plasma catecholamines in patients with acute myocardial infarction and in cardiac arrest . Q J Med. 1985;54:133-140. 42. Verrier RL, Lown B. Behavioral stress and cardiac arrhythmias . Ann Rev Physiol. 1984;46:155-176.Crossref 43. US Dept of Health and Human Services. Detection and diagnosis . In: Depression in Primary Care . Washington, DC: US Dept of Health and Human Services; 1993;1. 44. US Dept of Health and Human Services. Treatment of major depression . In: Depression in Primary Care . Washington, DC: US Dept of Health and Human Services; 1993;2.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 11, 1996

There are no references for this article.