Risks of Depression and Suicide After Diagnosis With Heart Failure: A National Cohort Study

Association between vitamin A intake and depression among patients with heart failure

AIMS

We aim to investigate the association between vitamin A intake and depression among patients with heart failure (HF).

METHODS AND RESULTS

In this cross-sectional study, data of HF patients were extracted from the National Health and Nutrition Examination Survey (NHANES) 2007-2020. The independent variable was vitamin A intake, and the dependent variable was depression. Weighted univariate and multivariate logistic regression models were performed to explore the association of vitamin A intake with depression in HF patients. A total of 999 HF patients were included, with a mean age of 66.19 (0.51) years, and 566 (52.49%) were male. And 197 patients have depression. Vitamin A intake ≥731.38 mcg was associated with lower incidence of depression [odds ratio (OR) = 0.37; 95% confidence interval (CI): 0.18-0.76] in HF patients. Similarly, the relationship between high vitamin A intake and lower odds of depression were also observed in subgroups of those aged >65 years (OR = 0.16; 95% CI: 0.04-0.55), males (OR = 0.35; 95% CI: 0.14-0.86), without hypertension (OR = 0.25; 95% CI: 0.11-0.58), without diabetes (OR = 0.30; 95% CI: 0.11-0.78), with hyperlipidaemia (OR = 0.23; 95% CI: 0.09-0.64), and with chronic kidney disease (CKD) (OR = 0.32; 95% CI: 0.13-0.80).

CONCLUSIONS

High vitamin A intake was associated with lower odds of depression in HF patients. Appropriate vitamin A supplementation may have potential benefit to the prevention of depression in HF patients. Additional prospective large-scale studies are required to confirm whether or not vitamin A could lead to decrease in depression symptoms.

Relationships between heart failure, depression, and anxiety: A Mendelian randomization study

Growing evidence suggests that heart failure (HF) is associated with an increased risk of depressive disorders and anxiety. However, the existing studies were observational and may have confounded and not reflected true causal relationships. This study collected genetic instruments about HF, depression, and anxiety from publicly available genetic summary data. Two-sample Mendelian randomization (MR) analysis was performed, with inverse-variance weighted designated as the primary approach for determining causal effects. Secondary analyses included MR-Egger regression and the weighted media method. Additionally, we conducted MR pleiotropy residual sum and outlier to address horizontal pleiotropy. Cochran Q test, MR-Egger intercept test, and leave-one-out analysis were used to assess the robustness of the findings. The significance is determined by a P-value below .05. Gene prediction result revealed that HF did not exhibit a significant association with elevated incidence of depression by inverse-variance weighted method no matter HF from the Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.93-1.18, P = .424 for major depressive disorder, MDD; OR = 1.01, 95% CI = 0.94-1.09, P = .782 for major depression) or the FinnGen Consortium (OR = 1.03, 95% CI = 0.92-1.15, P = .644 for MDD; OR = 1.00, 95% CI = 0.94-1.07, P = .962 for major depression). In contrast, the results of HF on anxiety exhibited inconsistency (OR = 1.60, 95% CI = 1.10-2.31, P = .013 for Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium; OR = 1.42, 95% CI = 0.91-2.21, P = .123 for FinnGen Consortium); however, a combined effect analysis indicated support causal relationship between HF and the risk of anxiety (OR = 1.52, 95% CI = 1.07-2.00, P < .001). Our findings did not reveal evidence to confirm a causal association between HF and depression. However, our results provide support for a causal effect of HF on the risk of anxiety.

Suicidal behaviour among patients with congestive cardiac failure in a Nigerian teaching hospital

Background

Suicidal behaviour is an established psychiatric complication of congestive cardiac failure (CCF), contributing significantly to morbidity and death by suicide. The magnitude and risk factors for suicidal behaviour among patients with CCF are yet to be unpacked, especially in developing nations such as Nigeria.

Aim

To determine the prevalence of suicidal behaviour and the risk factors associated with suicidal behaviour, among patients with CCF in Nigeria.

Setting

Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria.

Methods

A cross-sectional study was conducted among 98 randomly selected patients with a diagnosis of CCF. Participants were assessed with a socio-demographic and clinical factors questionnaire and Beck Scale of Suicidal Ideation. Chi-square test, t-test and logistic regression were used to analyse data.

Results

The prevalence of suicidal ideation and suicidal attempt among patients with CCF was 52% and 1%, respectively. No socio-demographic factor was significantly associated with suicidal ideation. Clinical factors associated with suicidal ideation were age at diagnosis (p = 0.042), aetiology of CCF (p = 0.001) and severity of CCF (p = 0.032). Only the severity of CCF (odds ratio [OR] = 20.557, p = 0.014) predicted suicidal ideation among patients with CCF.

Conclusion

Suicidal behaviour constitutes a huge burden among the outpatient CCF population. The identification of clinical risk factors for suicidal ideation (age at diagnosis, aetiology and severity of CCF) further illuminates a pathway to mortality among patients with CCF.

Contribution

The findings lend a voice to the need for screening for suicidal behaviour, suicide prevention programmes, surveillance systems and government policies that support mental health for patients with CCF.

Patients with cardiovascular disorders and suicidality: A systematic review and meta-analysis

SIGNIFICANCE

Findings from this study hold considerable significance, offering invaluable data on the correlation between specific physical health conditions and suicide risk in primary or general healthcare settings-an understudied yet critical area that has implications for the efficiency, cost, and burden of widespread suicide prevention strategies.

OBJECTIVE

To evaluate the suicide risks of patients with cardiovascular disorders compared to the general population, and to construct a disease-suicide risk predictive model, emphasizing the contribution of various diseases to the risk of suicide DATA SOURCES: For this study, we retrieved human research studies published up until June 2023 from PubMed, Cochrane Library, Embase, Web of Science, CINAHL, and PsycINFO, employing the search term "(((suicide) OR (self-harm) OR (suicidality)) AND ((cardiovascular diseases) OR (heart diseases)))." We also conducted searches on databases from countries referenced in the selected articles. We extracted data from existing works by Junting Chi and Dante Duarte to facilitate comparisons and ensure the compatibility of our methodology.

DATA EXTRACTION AND SYNTHESIS

The preregistered systematic review and meta-analysis followed Cochrane and PRISMA guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via I2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses were performed.

MAIN OUTCOMES AND MEASURES

Suicidal tendencies among cardiovascular disease patients from inception to the present: an examination of suicide ideation, planning, and attempts.

RESULTS

Of 17427 search results, 13 articles were included in the systematic review and meta-analysis. Meta-analysis showed a significantly higher suicidality in patients with cardiovascular disorders: general CVD (OR = 1.44, 95% CI 1.08-1.93; P < 0.01, I2 =91.7%), CHF (OR = 1.68, 95% CI 1.56-1.81; P < 0.05, I2 =60.2%), Ischemic HD (OR = 1.50, 95% CI 1.22-1.85; P < 0.01, I2 =91.4%), hypertension (OR = 1.15, 95% CI 1.08-1.23, P < 0.01, I2 =87.3%), dyslipidemia (OR = 0.83, 95% CI 0.75-0.92, P < 0.01, I2 =82.2%), cerebrovascular disease (OR=1.84, 95% CI 1.78-1.90, P = 0.617, I2 =0%). Cardiovascular disorders also showed a significantly elevated suicide mortality rate with a pooled SMR of 2.74 (95% CI: 2.19-3.43, P < 0.01, I2 =98.1%). In our further meta-analysis investigating suicide risk in 16 diseases including cardiovascular ones, a model was developed assigning each disease a score. Results indicated that, despite cardiovascular diseases' risk impact, mood disorders, substance abuse disorders, and depression were more significant contributors.

CONCLUSIONS AND RELEVANCE

This study, through a meta-analysis, reveals a link between cardiovascular disorders and increased suicide rates, making these patients primary targets for suicide prevention. And we've developed a model highlighting the contribution of multiple diseases, not just cardiovascular, to suicide risk.

Suicide Risk Among Patients With Heart Disease and Heart Failure

Heart disease is the leading cause of death in the United States (US). Suicide is the 12th leading cause of death. However, little is known about the risk of suicide in patients with heart disease and heart failure. Using Multiple Cause of Death data from the Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) database, we used a cross-sectional analysis to examine the risk of suicide in patients with heart disease and heart failure as compared with the general US population and in subgroups within the US. We assessed suicide rate in patients with heart disease and heart failure in the US population as a whole and stratified by race, time, urbanization levels, and census regions using the CDC WONDER Multiple Cause of Death database. Standardized mortality rates were calculated as observed deaths divided by expected deaths. As compared with the general population, patients with heart disease and heart failure had an elevated risk of suicide. This was true across racial and geographic subgroups. There was an elevated risk of suicide in patients with heart disease and heart failure in the United States. For heart disease, there were particular elevations in the Western US, and there was a particular elevation in Black Americans compared with the age-matched population.