The relationship between depression and cardiovascular disease

Depression, physical activity, and incident cardiovascular disease among American Indians: The strong heart family study

Background

Little is known about the relationship of depression with incident cardiovascular disease (CVD) among American Indians (AIs), a population with a high burden of depressive symptoms and CVD. In this study, we examined the association of depressive symptoms with CVD risk among AIs and assessed whether an objective marker of ambulatory activity influenced the relationship.

Methods

The study comprised participants from the Strong Heart Family Study, a longitudinal study of CVD risk among AIs free of CVD at baseline (2001-2003) and who participated in a follow-up examination (n = 2209). The Center for Epidemiologic Studies of Depression Scale (CES-D) was used to assess depressive symptoms and depressive affect. Ambulatory activity was measured using Accusplit AE120 pedometers. Incident CVD was defined as new myocardial infarction, coronary heart disease, or stroke (through 2017). Generalized estimating equations were used to examine the association of depressive symptoms with incident CVD.

Results

27.5% of participants reported moderate or severe depressive symptoms at baseline and 262 participants developed CVD during follow-up. Compared to participants who reported no depressive symptoms, the odds ratios for developing CVD among those who reported mild, moderate, or severe symptoms were: 1.19 (95% CI: 0.76, 1.85), 1.61 (95% CI: 1.09, 2.37), and 1.71 (95% CI: 1.01, 2.91), respectively. Adjustment for activity did not alter findings.

Limitations

CES-D is a tool used to identify individuals with depressive symptoms and not a measure of clinical depression.

Conclusion

Higher levels of reported depressive symptoms were positively associated with CVD risk in a large cohort of AIs.

The Chain-Mediating Effect of Obesity, Depressive Symptoms on the Association between Dietary Quality and Cardiovascular Disease Risk

In order to explore the relationship between the Healthy Eating Index (HEI-2015) and cardiovascular disease (CVD), and the mediating role of obesity and depressive symptoms, we used the data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) for further study. A total of 12,644 participants were included in the study. The HEI was derived using NHANES personal food data and USDA Food Pattern Equivalence Database (FPED) dietary data. The risk of cardiovascular disease was determined using the Framingham Heart Study's multifactorial calculation tool. The weighted multiple logistic regression model was used to explore the association between the HEI-2015 and CVD, and the generalized structural equation was used to explore the mediating effects of obesity and depression, respectively and jointly. Higher HEI-2015 scores were associated with a lower risk of CVD compared to lower quartiles. Obesity, depressive symptoms, and their chain effects all played significant mediating roles in the association between the HEI-2015 and CVD, with proportional mediations of 9.03%, 2.23% and 0.25%, respectively. Our results suggest that higher dietary quality is associated with a lower risk of CVD, mediated by obesity, depressive symptoms, and the chain effect of obesity and depressive symptoms.

Evidence of Anxiety, Depression and Learning Impairments following Prenatal Hypertension

Background: Hypertensive disorders of pregnancy, such as Preeclampsia (PreE) and HELLP (hemolysis, elevated liver enzyme, low platelet) syndrome, affects approximately 5–10% of pregnancies and increases the risk of women developing disorders, such as anxiety or depression, in the postpartum period. Using preclinical rodent models, we set out to determine whether rats with a history of PreE or HELLP had evidence of anxiety, depression or cognitive impairment and whether immune suppression during pregnancy prevented these changes in mood and/or cognition. Methods: Timed-pregnant rats were infused with sFlt-1 and/or sEng to induce PreE or HELLP beginning on gestational day 12. After delivery, a battery of validated behavioral assays was used to assess post-partum depression, anxiety and learning. Results: There was no negative effect on maternal pup interaction due to PreE or HELLP; however, hypertensive dams spent more time immobile in the forced swim test (p < 0.0001). Hypertensive dams also spent less time in the open area of the open field (p = 0.001). There were no significant changes in recognition memory (p = 0.08); however, spatial learning was impaired in hypertensive dams (p = 0.003). Immobility time in the forced swim test was positively correlated with increased circulating S100B (p = 0.04), while increased time spent in the outer zones of the open field was negatively correlated with BDNF levels (p < 0.0001). Conclusion: The results from this study suggest that hypertensive pregnancy disorders are associated with depression, anxiety and learning impairments in the post-partum period.

Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study

BACKGROUND

Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas.

METHODS

The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person's primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village's Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects' electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention.

DISCUSSION

The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT01938963 ; First posted: September 10, 2013.

The Role of Family Routines in the Intergenerational Transmission of Depressive Symptoms between Parents and their Adolescent Children

Whereas previous research on environmental factors implicated in the intergenerational transmission of depression has tended to focus on the role of parenting quality (e.g., harshness), the current study sought to assess whether structural aspects of families may contribute to depression-relevant affective and immune processes in youths. Specifically, the present study examined the role of family routines in linking parental depressive symptoms to youth emotion regulation, a depression-relevant marker of low-grade inflammation, and depressive symptoms in youths. 261 parent-adolescent dyads reported on their own depressive symptoms, family routines, and youths' emotion regulation abilities. In addition, peripheral blood was drawn from youths to assess levels of the proinflammatory cytokine interleukin 6 (IL-6). Path analyses provided support for a model in which parental depressive symptoms related to fewer family routines, which in turn were associated with higher IL-6 and depressive symptoms in youths as well as marginally associated with worse youth emotion regulation. Moreover, family routines were found to statistically account for part of the association between parent- and youth- depressive symptoms. Together, these results suggest that family routines may represent an additional facet of the family environment that can potentially contribute to the intergenerational transmission of depressive symptoms.

Agomelatine in the treatment of mild-to-moderate depression in patients with cardiovascular disease: results of the national multicenter observational study PULSE

BACKGROUND

PULSE was a large, observational, multicenter study designed to evaluate the efficacy and safety of agomelatine in the treatment of major depression in patients with cardiovascular disease (CVD).

METHODS

Patients with mild-to-moderate major depressive episodes, without psychotic symptoms, were treated as outpatients or in cardiac facilities in 46 regions of Russia. The patients received antidepressant monotherapy with agomelatine 25 or 50 mg, once daily, for 12 weeks.

RESULTS

The mean age of the patients (N=896) was 51.4±9.9 years, and 68.5% were women. A progressive improvement in the total score on both the anxiety and depression subscales of the Hospital Anxiety and Depression Scale (HADS), from 13.1±3.8 and 13.9±3.1 at baseline to 3.7±2.8 and 3.9±3.0, respectively, was observed by 12 weeks. All individual HADS scores improved rapidly; the change between visits was also significant (P<0.0001). The majority (84.6%) were remitters (HADS total score <7) by 12 weeks. The Clinical Global Impression - Severity and Improvement scores also improved quickly. The mean hypochondria index (Whiteley Index) decreased significantly from 48.0±11.8 at baseline to 25.2±9.2 at 12 weeks (P<0.0001). The main hemodynamic indices improved or remained stable, and biochemical parameters reflecting liver function (aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, total bilirubin) did not exceed three times the upper limits of established norms.

CONCLUSION

Agomelatine resulted in statistically significant improvements in depressive symptoms, anxiety, and hypochondria in depressed patients with CVD, and had good tolerability. Our data suggest that agomelatine is safe to treat depression in patients with CVD.

Self-reported health, health behaviors, attitudes, and beliefs of regional mental health consumers

PURPOSE

This article reports baseline data from a randomized controlled trial investigating the impact of a specialist cardiometabolic healthcare nurse on physical health care.

DESIGN AND METHODS

Survey of community-based mental health consumers randomized to a cardiometabolic health nurse intervention.

FINDINGS

Findings show a high prevalence of respiratory conditions, hypercholesterolemia, hypertension, and low quality of life. Participants reported regular blood pressure but infrequent cholesterol and blood glucose testing. Few received advice about smoking cessation, diet, or physical activity. Participants were mostly satisfied with physical healthcare provision; however, positive health behaviors are lacking.

PRACTICE IMPLICATIONS

An individualized intervention based on knowledge and attitudes may be necessary.

Parental encouragement of healthy behaviors: adolescent weight status and health-related quality of life

BACKGROUND

Obesity is a major health concern for adolescents, with one in four being overweight or obese in Australia. The purpose of this study was to examine the moderation effect of parental encouragement of healthy behaviors on the relationship between adolescent weight status and Health-Related Quality of Life (HRQoL).

METHODS

Baseline data were collected from 3,040 adolescents participating in the It's Your Move project, conducted in the Barwon South-West region of Victoria, in 2005. The Paediatric Quality of Life Inventory was used to measure HRQoL, and parental encouragement was derived from purposely designed self-report items. Weight status was calculated according to World Health Organization growth standards from measured weight and height. Linear regression analyses modeled direct relationships and interaction terms. Analyses were adjusted for age, sex, physical activity level, nutrition and school attended.

RESULTS

Higher levels of parental encouragement, as compared to low encouragement, were positively associated with higher global HRQoL scores, particularly in the physical functioning domain. To a lesser degree, high parental encouragement was also associated with higher scores on the psychosocial domain. Obese weight status showed a significant association with lower HRQoL on all scales. Parental encouragement significantly moderated the inverse relationship between overweight status and physical wellbeing.

CONCLUSIONS

Findings suggest that parental encouragement of healthy behavior is associated with increased HRQoL scores for adolescents. Whilst more research is needed to validate the significant interaction effect, main effects suggest that parental encouragement of healthy behavior is an important factor in adolescent wellbeing and should be considered when developing prevention and clinical interventions for obesity.

The effects of apoptosis vulnerability markers on the myocardium in depression after myocardial infarction

BACKGROUND

There is an increased incidence of major depressive disorder (MDD) in individuals after myocardial infarction (MI), but the pathophysiological processes mediating this association are unclear. Our previous study demonstrated an increase in pro-apoptotic pathways in the myocardium and hippocampus in MDD, which was reversed by venlafaxine. This study aimed to attempt to confirm the effects of apoptosis vulnerability markers on the myocardium in a model of depression after myocardial infarction.

METHODS

Rats were divided into four groups: sham (N = 8), depression (N = 8, chronic mild unpredictable stress and separation were used in the depression group), MI (N = 13) and post-MI depression (N = 7). The rats in all four groups underwent the same open field and sucrose preference behavioral tests. Evan Blue staining was used to determine the area at risk of myocardial infarction in the left ventricle, and 2,3,5-triphenyl tetrazolium chloride (1.5% TTC) dye was used to detect the size of the myocardial infarction. The expression of bax and bcl-2 protein in the myocardium was investigated by immunohistochemistry, and the mRNA expression of bax, bcl-2 and caspase-3 in the myocardium was investigated by real time RT-PCR. Apoptosis was estimated in the myocardium by measuring the Bax:Bcl-2 ratio.

RESULTS

In the depression and post-MI depression rats, there were significantly decreased movements and total sucrose consumption, modeling behavioral deficits and an anhedonic-like state. In terms of myocardial infarction size, no difference was seen between the MI and post-MI depression groups. There was an up-regulated Bax:Bcl-2 ratio in the depression, MI and post-MI depression groups. Furthermore, in the latter group, there was a greater up-regulated Bax:Bcl-2 ratio. However, caspase-3 did not differ among the four groups.

CONCLUSIONS

These results of this animal model suggest that active pro-apoptotic pathways may be involved in the nexus between myocardial infarction and depression. This mechanism may be germane to understanding this relationship in humans.

Increased prevalence of chronic physical health disorders in Australians with diagnosed mental illness

OBJECTIVE

To compare chronic physical health disorder prevalence amongst Australian adults with and without mental illness.

METHOD

Total n=1,716 participants (58% female) with a mean age of 52 ± 13 years (range: 18 to 89 years) completed an online survey of Australian adults in 2010. Outcome measures including prevalence of chronic physical conditions and self-reported body mass index (BMI) in n=387 (23%) with a self-reported mental illness diagnosis were compared to respondents without mental illness.

RESULTS

A significantly higher proportion of participants with mental illness were obese (BMI ≥ 30; 31 vs 24%, p=0.005). Adjusted odds ratios (OR) for coronary heart disease, diabetes, chronic bronchitis or emphysema, asthma, irritable bowel syndrome, and food allergies or intolerances (OR range: 1.54-3.19) demonstrated that chronic physical disorders were significantly more common in participants with a mental illness.

CONCLUSION

Australian adults with a diagnosis for mental illness have a significantly increased likelihood of demonstrating chronic physical health disorders compared to persons without mental illness.

IMPLICATIONS

Health professionals must be alert to the increased likelihood of comorbid chronic physical disorders in persons with a mental illness and should consider the adoption of holistic approaches when treating those with either a mental or physical illness.

Venlafaxine modulates depression-induced behaviour and the expression of Bax mRNA and Bcl-xl mRNA in both hippocampus and myocardium

OBJECTIVES

Major depressive disorder is associated with progressive brain changes and is frequently comorbid with cardiovascular disease. There may be shared pathophysiological pathways between cerebral and myocardial dysfunction that impact on apoptosis related proteins. Our aim was to examine behaviour changes of rats with chronic mild stress (CMS), explore the expression of Bax and Bcl-xl in the hippocampus and myocardium, and additionally evaluate the effects of venlafaxine on these molecular mechanisms.

METHODS

Rats were randomly divided into three groups. The behaviour was assessed using the open field and sucrose consumption tests. Gene expression was measured by RT-PCR.

RESULTS

In CMS, there was a significant reduction of movements and sucrose consumption, an increased Bax level and a decreased Bcl-xl level in both the hippocampus and myocardium. The venlafaxine group showed an increase in movements and sucrose consumption, as well as upregulated expression of Bcl-xl and downregulated expression of Bax in both the hippocampus and myocardium.

CONCLUSIONS

These results demonstrate that in CMS, there is an increase in pro-apoptotic pathways that is reversed by venlafaxine. This suggests that there are shared active biochemical pathways that may play a role in the process of neuroprogression that is seen in depression and cardiovascular disorders.

Effects of depression, anxiety, self-esteem, and health behaviour on neonatal outcomes in a population-based Hungarian sample

OBJECTIVE

To investigate possible associations of maternal antenatal depression, anxiety and self-esteem with negative neonatal outcomes controlling for the effects of demographic covariates and health behaviour in a Hungarian sample.

STUDY DESIGN

A population-based monitoring system was established in 10 districts of health visitors in Szombathely, Hungary, covering every woman registered as pregnant between February 1, 2008 and February 1 2009. Three hundred and seven expectant women in the early stage of their pregnancy were surveyed using the Short Form of Beck Depression Inventory for the measurement of depression and the Spielberger Trait-Anxiety Inventory for the measurement of anxiety. Self-esteem was evaluated by the Rosenberg's Self-Esteem Scale. At the end of the follow-up period, data on 261 mothers and their singleton neonates were available. The relationship between the explanatory and outcome variables (birth weight, length, chest circumference, gestational age, and 1- and 5-min Apgar score) was tested in girls and boys separately by multiple linear regression analysis (Forward method). Categorical variables were used as "dummy variables".

RESULTS

Maternal depression, anxiety and health behaviour did not show any association with neonatal outcomes. Higher level of maternal self-esteem was associated with higher birth weight and birth length in boys and higher birth length in girls. Maternal education positively correlated with birth length, gestational age and chest circumference in boys, and with birth length in girls. In girls, maternal socioeconomic status showed a positive association with birth weight and gestational age, while common law marriage had a negative effect on birth weight and chest circumference.

CONCLUSIONS

Lower level of maternal self-esteem possibly leads to a higher level of maternal stress which may reduce fetal growth via physiologic changes. Gender differences in associations between demographic factors and neonatal outcome measures indicate differences in fetal development between boys and girls.

Barriers of antenatal folate-supplementation: The role of depression and trait-anxiety on periconceptional folate-intake

Abstract Objective. The aim of the research was to reveal the effect of antenatal depressive symptoms and trait-anxiety on folate supplementation. Higher levels of depression, and trait-anxiety were hypothesized to be associated with insufficient folate intake among pregnant women in early pregnancy. Methods. Level of depressive symptoms, trait-anxiety, self-esteem, social capital, self-related health, and demographic factors (age, number of siblings, marital, educational, employment, and socioeconomic-status) were established among 185 Hungarian women in the first trimester of their pregnancies. Depressive symptoms and trait-anxiety were evaluated with the Short Hungarian Version of the Beck Depression Inventory and the Hungarian version of the Spielberger State-Trait Anxiety Inventory form Y (STAI-Y). Results. The higher levels of both trait-anxiety and self-esteem decreased the folate-intake significantly, OR=0.925 (95%CI=0.863-0.991; P=0.026) and OR=0.897 (95%CI=0.808-0.996; P=0.041) while depressive symptoms did not have an effect on it. The lower level of education (less than 8 elementary years) had similar effects (OR=0.228 [95%CI=0.064-0.817], P=0,023). The lack of trust had a significant role too (P=0.043): those, who were distrustful with other people, also had a lower chance of supplementation (OR=0.620; 95%CI=0.390-0.986). Conclusions. The way to increase the openness towards folate-supplementation leads through the treatment of psychological disturbances and the restoration of social trust.

Prevalence of depression and anxiety in early pregnancy on a population based Hungarian sample

Hazánkban nem történt átfogó vizsgálat a várandósság alatti depresszió és szorongás gyakoriságának feltérképezésére. Célkitűzés: A szerzők a hiányzó adatok megállapításán túl célul tűzték ki azok szociodemográfiai összefüggéseinek vizsgálatát is. Módszer: Szombathely 10 védőnői körzetében populációs alapú monitoringot hoztak létre minden nőről, aki 2008. február 1. és 2009. február 1. között került terhességi nyilvántartásba. Háromszázhét fő kora terhességi várandóson a depressziót a rövid Beck-depresszió-kérdőívvel, a szorongást a Spielberger-féle vonásszorongás-kérdőívvel mérték. Eredmények: A várandósok 17,9%-a (95%MT: 13,0–21,5%) jelzett depressziós tüneteket, 1,0%-uk súlyos depressziót mutatott. A szorongásos tüneteket mutatók aránya 14,6% (95%MT: 10,7–18,6%) volt, míg 4,2% kifejezetten szorongott. Szignifikánsan magasabb szintű depressziót és szorongást jeleztek a szakmunkás képesítésnél kevesebbel rendelkezők, a legalacsonyabb jövedelműek és a munkahellyel nem rendelkezők. Ezenfelül szignifikánsan magasabb depressziót jeleztek a 18 évnél fiatalabbak és az élettársi kapcsolatban élők. Következtetések: A vizsgált mintában a kora terhességi depresszió és szorongás prevalenciája lényegében megegyezik a fejlett piacgazdaságú országokban megfigyelhető gyakoriságokkal.

Self-reported depression and cardiovascular risk factors in a community sample of women

The authors examined data collected from a randomly selected, representative sample of 755 women (ages 23-97 years) from southeastern Australia. Self-report questionnaires were utilized to determine lifetime rates of depression and cardiovascular risk factors within the study sample. A lifetime history of depression (LHx) was reported by 145 women (19.20%). There were no associations between indices of weight, cholesterol levels, hypertension, inactivity, diabetes, and LHx. However, a history of smoking increased the odds of reporting an LHx, whereas women with self-reported angina were more than four times more likely to report an age-adjusted LHx.

Depression and pain: an overview

BACKGROUND

Depression and pain are both burdensome ailments that affect a major proportion of the population. It is evident that depression and pain frequently coexist, with treatment and outcome implications.

OBJECTIVE

To review the literature on the nature, prevalence and co-morbidity of depression and pain, the biological and psychological mechanisms involved and treatment options, thus presenting a broad overview of the current information available.

METHODS

Relevant sources were identified from PubMed and Medline databases using a combination of keywords including depression, pain, prevalence, co-morbidity, biological and psychological mechanisms, serotonin (5-HT), norepinephrine (NE), hypothalamic-pituitary-adrenal (HPA) axis, amygdala, functional magnetic resonance imaging (fMRI), antidepressant and psychological therapy.

RESULTS

It is evident from the research that depression and pain are common co-morbidities. Pain as a physical symptom of depression affects approximately 65% of patients, leading to less favourable outcomes and greater health care utilization. Moreover, depression is a common feature in chronic pain patients and can affect pain threshold and tolerance. Evidence from biological and psychological studies has revealed mechanisms that link chronic pain to depression. Several classes of anti-depressants and psychological interventions have been used successfully in the treatment of somatic symptoms of depression and for a variety of pain syndromes.

CONCLUSIONS

Pain and depression are linked by overlapping phenomenology, neurobiology and therapy. They are mutually interacting, and the interaction has significant treatment and outcome implications.