Cardiovascular disease, depression and mortality: the Health In Men Study

Mediating effect of depression on the association between cardiovascular disease and the risk of all-cause mortality: NHANES in 2005-2018

BACKGROUND

Cardiovascular disease (CVD) patients are more likely to have depression than general populations, and meanwhile, depression increased all-cause mortality. However, the interaction effect of depression on CVD and all-cause mortality has not been reported yet.

HYPOTHESIS

Herein, we speculate that depression may play an intermediate role in the association of CVD and all-cause mortality.

METHODS

Demographic and clinical data of 33,156 adults (≥20 years old) were extracted from the National Health and Nutrition Examination Survey (NHANES) database in 2005-2018 in this retrospective cohort study. Weighted univariate and multivariate COX regression analyses were used to screen the covariates and to explore the relationship of CVD and depression. Distribution-of-product method was used to assess the mediating effect of depression on the association between CVD and all-cause mortality. The mediating effect of depression was also explored in age, gender, diabetes mellitus (DM), and dyslipidemia subgroups. The evaluation indexes were odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs).

RESULTS

Among the participants, 11 514 had CVD, 5844 had depression, and 4759 were died. After adjusting for covariates, CVD was related to high odds of depression (OR = 1.94). Depression played an intermediate role in CVD and all-cause mortality (HR = 1.23) with a mediational percentage of 9.13%. Subgroup analyses also showed this mediating effect existed in adults of different age, gender, DM and dyslipidemia status (all p < .05).

CONCLUSION

The intermediate effect of depression may help clinicians to early identify high-risk populations and provide some reference for disease management and mortality reduction.

Association of depression with all-cause and cardiovascular mortality among US adults with high and low baseline risk of cardiovascular disease

The intervention of depression was considered a prevention and treatment option for cardiovascular disease (CVD). However, evidence regarding whether association of depression with mortality differed among people at high or low risk of CVD yielded conflicting results. We aimed to investigate associations between depression and all-cause and CVD mortality among 3854 and 3044 US adults at high and low baseline risk of CVD, respectively. Among participants at high risk of CVD, depression and per 5-point increase in PHQ-9 score were associated with 81% (HR=1.81, 95%CI: 1.15-2.86) and 33% (HR=1.33, 95%CI: 1.14-1.55) increased all-cause mortality, respectively. We did not find statistically significant associations between depression (HR=1.40, 95%CI: 0.67-2.95) and PHQ-9 score (HR=1.28, 95%CI: 1.00-1.63) with CVD mortality due to a small number of mortality events. Among people with low risk of CVD, each 5-point increment in PHQ-9 score was associated with all-cause mortality (HR=1.26, 95%CI: 1.02-1.56), while there was no statistically significant association of depression with all-cause mortality (HR=1.69, 95%CI: 0.75-3.81) and CVD mortality (HR=1.99, 95%CI: 0.83-4.81). This study found that depression was associated with all-cause mortality among individuals at a high baseline risk of CVD, but no significant association was observed in people at a low baseline risk of CVD.

Association between housing environment and depressive symptoms among older people: a multidimensional assessment

Background

Depression is a common mental disorder among older people. This study aimed to assess the association between housing environment factors and depressive symptoms among older people using a multidimensional assessment method.

Methods

The study uses a population-based cross-sectional design. A total of 950 participants aged ≥ 60 years were selected using a complex multistage sampling design from 22 locations in China. All data were collected using questionnaires by face-to-face interviews. A total of 938 participants were included in the analysis, and 17.1% of males and 23.1% of females were identified as having depressive symptoms. The depressive symptoms were assessed using the 15-item Geriatric Depression Scale. The housing environment was assessed on the basis of four dimensions: physical, social, psychological, and cognition and physical function. Cumulative logistic regression analysis was used to evaluate the association between housing environment and depressive symptoms.

Results

The Cochran–Armitage trend test showed that the depressive symptom scores were linearly negatively associated with self-assessed housing environment, living arrangement, life satisfaction, and other physical environment factors and linearly positively associated with cognitive and physical function scores. The results of cumulative logistic regression analysis showed that the housing environment was significantly associated with depressive symptoms. The participants’ self-assessed housing environment was strongly associated with the levels of depressive symptom scores, and the odds ratio was 3.47 (95% CI, 1.14–10.82, P = 0.003).

Conclusion

The housing environment was significantly associated with depressive symptoms. Our results suggest that multi-dimensional assessment in the housing environment may be an effective way to develop intervention strategies of depressive symptoms among older people.

Risk factors and consequences of depression in later life: Findings from the health in men study (HIMS)

Background

The Health In Men Study (HIMS) has been collecting data on risk factors and health events for the past 25 years in a large community-representative sample of older men. This paper summarises key-findings of the study about depression in later life.

Methods

Narrative review of selected HIMS studies published over the past 15 years describing risk factors associated with prevalent and incident depression in older men, as well as clinical outcomes associated with depression.

Results

Data from HIMS showed that cardiovascular diseases and risk factors are associated with increased risk of depression, but this association is neither specific nor causative. Findings from HIMS are not supportive of the vascular hypothesis of depression in later life. Studies investigating lifestyle have generated risk tables capable of guiding risk reduction strategies. Other potentially modifiable risk factors associated with depression in the HIMS cohort included abnormal allostatic inflammatory response, high plasma homocysteine and low testosterone. The results from HIMS also showed that depression is most likely a prodromal manifestation of dementia rather that a true risk factor, but it increases frailty and mortality. The association between depression and suicide in older men is largely mediated by deteriorating health and increasing frailty.

Conclusion

HIMS has contributed to advance knowledge about risk factors associated with depression, as well as the health consequences of depression in older men. The study is ongoing and the investigators welcome the opportunity to share data with colleagues who are interested in the health of older people.

Impacts of heart disease, depression and their combination on all-cause mortality in older people: a rural community-based cohort study in China

OBJECTIVE

To assess the impact of heart disease (HD) combined with depression on all-cause mortality in older people living in the community.

DESIGN

A population-based cohort study.

PARTICIPANTS

We examined the data of 1429 participants aged ≥60 years recruited in rural areas in Anhui province, China. Using a standard method of interview, we documented all types of HD diagnosed by doctors and used the validated Geriatric Mental Status-Automated Geriatric Examination for Computer Assisted Taxonomy algorithm to diagnose any depression for each participant at baseline in 2003. The participants were followed up for 8 years to identify vital status.

MEASUREMENTS

We sought to examine all-cause mortality rates among participants with HD only, depression only and then their combination compared with those without these diseases using multivariate adjusted Cox regression models.

RESULTS

385 deaths occurred in the cohort follow-up. Participants with baseline HD (n=91) had a significantly higher mortality (64.9 per 1000 person-years) than those without HD (42.9). In comparison to those without HD and depression, multivariate adjusted HRs for mortality in the groups of participants who had HD only, depression only and both HD and depression were 1.46 (95% CI 0.98 to 2.17), 1.79 (95% CI 1.28 to 2.48) and 2.59 (95% CI 1.12 to 5.98), respectively.

CONCLUSION

Older people with both HD and depression in China had significantly increased all-cause mortality compared with those with HD or depression only, and without either condition. Psychological interventions should be taken into consideration for older people and those with HD living in the community to improve surviving outcome.

Bidirectional association between depressive symptoms and carotid atherosclerosis in community-based older adults in China

We explored the bidirectional association between depressive symptoms and measures of carotid atherosclerosis. This study included 1155 participants aged 55 years and older. Depressive symptoms was assessed by 30-item Geriatric Depression Scale (GDS-30) score. Common carotid artery intima-media thickness (CCA-IMT), carotid plaques and carotid stenosis were measured at both common carotid arteries using an edge detection system. In part 1, we explored the risk of CCA-IMT on depressive symptoms. We identified a significantly increased risk of depressive symptoms with the severity of carotid atherosclerosis. ORs (95%CI) of CCA-IMT thickening, carotid plaque and carotid stenosis for depressive symptoms were 1.48(0.72-3.03), 2(1.03-3.85) and 5.29(2.16-12.97) comparing with normal CCA-IMT in adjusting all potential risk factors models. When using carotid atherosclerosis as a continuous variable, the OR for depressive symptoms was 1.32 (95%CI 1.16-1.49) with every 0.1mm elevated in CCA-IMT after adjustment for all potential confounders. In part 2, we explored the risk of depressive symptoms on carotid atherosclerosis. We found elevated depressive symptoms significantly increased the risk of carotid atherosclerosis in multi-factor adjusted models [OR (95%CI): 1.65(1.10-2.47)]. When using depressive symptoms as a continuous variable, the ORs for carotid artery atherosclerosis were 1.32 (95%CI 1.16-1.49) with every 1 GDS-30 score elevated after adjustment for all convenient risk factors. The current study demonstrated the bidirectional links of carotid atherosclerosis measures with depressive symptoms. More cohort study and clinical trial focusing on the issue need to be explored in the future.

Depression Levels Following Discharge Predict Quality of Life in Heart Disease Patients

Abstract Depression and stress have been related with poor Health Related Quality of Life (HRQoL) prognosis. However, it is not clear when these depressive symptoms should be measured. A sample of 177 Coronary Heart Disease patients were followed for 15 months aimed to compare the effect of depression and stress measure at time of hospitalization and three months later on the physical HRQoL trajectory. Linear growth models’ results showed that depression and stress after discharge are negatively correlated with the physical HRQoL and depressive symptoms negatively affect the prognosis of these patients.

Role of Late-Life Depression in the Association of Subclinical Cardiovascular Disease With All-Cause Mortality: Cardiovascular Health Study

OBJECTIVES

To evaluate whether late-life depression mediates the association of subclinical cardiovascular disease (CVD) with all-cause mortality.

METHOD

Using data from 3,473 Cardiovascular Health Study participants, the Cox proportional hazards model was used to examine the direct and indirect (via late-life depression) effects of the association between baseline subclinical CVD and all-cause mortality with weights derived from multivariable logistic regression of late-life depression on subclinical CVD.

RESULTS

Subclinical CVD led to a higher risk of all-cause mortality (hazard ratio [HR] = 1.51, 95% confidence interval, [CI] = [1.42, 1.94]). Total effect of subclinical CVD on all-cause mortality was decomposed into direct (HR = 1.41, 95% CI = [1.37, 1.58]) and indirect (HR = 1.07, 95% CI = [1.01, 1.23]) effects; 16.3% of the total effect of subclinical CVD on all-cause mortality was mediated by late-life depression.

DISCUSSION

Late-life depression accounts for little, if any, of the association between subclinical CVD, a risk factor of all-cause mortality, and all-cause mortality.

Association of long-term patterns of depressive symptoms and attention/executive function among older men with and without human immunodeficiency virus

Older HIV-infected men are at higher risk for both depression and cognitive impairments, compared to HIV-uninfected men. We evaluated the association between longitudinal patterns of depressive symptoms and attention/executive function in HIV-infected and HIV-uninfected men aged 50+ years to understand whether HIV infection influenced the long-term effect of depression on attention/executive function. Responses to the Center for Epidemiologic Studies-Depression scale and attention/executive function tests (Trail Making Test Part B and Symbol Digit Modalities Test) were collected semiannually from May 1986 to April 2015 in 1611 men. Group-based trajectory models, stratified by HIV status, were used to identify latent patterns of depressive symptoms and attention/executive function across 12 years of follow-up. We identified three depression patterns for HIV-infected and HIV-uninfected men (rare/never 50.0 vs. 60.6%, periodically depressed 29.6 vs. 24.5%, chronic high 20.5 vs.15.0%, respectively) and three patterns of attention/executive function for HIV-infected and HIV-uninfected men (worst-performing 47.4 vs. 45.1%; average 41.9 vs. 47.0%; best-performing 10.7 vs. 8.0%, respectively). Multivariable logistic regression models were used to assess associations between depression patterns and worst-performing attention/executive function. Among HIV-uninfected men, those in the periodically depressed and chronic high depressed groups had higher odds of membership in the worst-performing attention/executive function group (adjusted odds ratio [AOR] = 1.45, 95% CI 1.04, 2.03; AOR = 2.25, 95% CI 1.49, 3.39, respectively). Among HIV-infected men, patterns of depression symptoms were not associated with patterns of attention/executive function. Results suggest that HIV-uninfected, but not HIV-infected, men with chronic high depression are more likely to experience a long-term pattern of attention/executive dysfunction.

Angiogenesis inhibition and depression in older men

BACKGROUND

Cardiovascular diseases have been associated with depression in later life, and a potential mechanism is inhibition of angiogenesis. We designed this study to determine if depression is associated with higher serum concentration of endostatin, an endogenous angiogenesis inhibitor.

METHODS

We performed a cross-sectional examination of a random sample of men aged 69-86 years. Those who scored 7 or higher on the 15-item Geriatric Depression Scale were deemed depressed. We determined the concentration of serum endostatin using a reproducible assay. Other measures included age, education, body mass index, smoking, history of depression, use of antidepressants, hypertension, diabetes, coronary heart disease and stroke, high sensitivity C-reactive protein, plasma homocysteine, triglycerides and cholesterol. We used logistic regression to investigate the association between endostatin and depression, and adjusted the analyses for confounding factors.

RESULTS

Our sample included 1109 men. Sixty-three (5.7%) men were depressed. Their serum endostatin was higher than that of nondepressed participants (p = 0.021). Men in the highest decile of endostatin had greater adjusted odds of depression (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.03-3.06). A doubling of endostatin doubled the odds of depression (OR 1.93, 95% CI 1.31-2.84). The probability of depression increased with the concentration of endostatin in a log-linear fashion up to a maximum of about 20%-25%.

LIMITATIONS

The cross-sectional design limits the study's ability to ascribe causality to the association between high endostatin and depression.

CONCLUSION

Serum endostatin is associated with depression in older men. It remains to be established whether correction of this imbalance is feasible and could decrease the prevalence of depression in later life.

The Kimberley assessment of depression of older Indigenous Australians: prevalence of depressive disorders, risk factors and validation of the KICA-dep scale

OBJECTIVE

This study aimed to develop a culturally acceptable and valid scale to assess depressive symptoms in older Indigenous Australians, to determine the prevalence of depressive disorders in the older Kimberley community, and to investigate the sociodemographic, lifestyle and clinical factors associated with depression in this population.

METHODS

Cross-sectional survey of adults aged 45 years or over from six remote Indigenous communities in the Kimberley and 30% of those living in Derby, Western Australia. The 11 linguistic and culturally sensitive items of the Kimberley Indigenous Cognitive Assessment of Depression (KICA-dep) scale were derived from the signs and symptoms required to establish the diagnosis of a depressive episode according to the DSM-IV-TR and ICD-10 criteria, and their frequency was rated on a 4-point scale ranging from 'never' to 'all the time' (range of scores: 0 to 33). The diagnosis of depressive disorder was established after a face-to-face assessment with a consultant psychiatrist. Other measures included sociodemographic and lifestyle factors, and clinical history.

RESULTS

The study included 250 participants aged 46 to 89 years (mean±SD = 60.9±10.7), of whom 143 (57.2%) were women. The internal reliability of the KICA-dep was 0.88 and the cut-point 7/8 (non-case/case) was associated with 78% sensitivity and 82% specificity for the diagnosis of a depressive disorder. The point-prevalence of a depressive disorder in this population was 7.7%; 4.0% for men and 10.4% for women. Heart problems were associated with increased odds of depression (odds ratio = 3.3, 95% confidence interval = 1.2,8.8).

CONCLUSIONS

The KICA-dep has robust psychometric properties and can be used with confidence as a screening tool for depression among older Indigenous Australians. Depressive disorders are common in this population, possibly because of increased stressors and health morbidities.

Support groups and cardiac rehabilitation: effects of partner participation on anxiety and depression

This study analyzes the effect on levels of patient anxiety and depression of a partner joining a cardiac rehabilitation program support group, also taking into account the sex of the patient. The study was undertaken using a two-group comparison design with pre-and post-test measures in non-equivalent groups. The sample comprised patients in the cardiac rehabilitation program (CRP) at the Ramón y Cajal Hospital, Madrid (Spain). Analysis of covariance (ANCOVA) showed direct effects of sex and partner participation in support groups on the anxiety trait. Similarly, interaction effects were observed between the sex variable and partner participation. These results indicate the pertinence of designing separate groups for patients and partners.

Cardiovascular diseases do not influence the mental health outcome of older men with depression over 6 years

BACKGROUND

The concept of 'vascular depression' implies that cardiovascular disease facilitates the onset or persistence of depression in later life, and that the natural course of depression should differ according to whether or not vascular pathology is present.

METHODS

Population-based cohort of 431 older men were diagnosed with depression (prevalent cases) and followed for up to 6 years. We used the Western Australian Data Linkage System to establish the presence of cardiovascular disease (CVD, documented history of coronary heart disease or stroke) and subsequent persistence or recurrence of depression during follow up (ICD-10 codes). Other measures recorded: age, place of birth, education, social support and disadvantage, smoking history, sensory impairment, medical morbidity burden and use of antidepressants.

RESULTS

The age of participants ranged from 69 to 86 years and CVD was present in 212 (49.2%) of them. Depressed men with and without CVD had a similar distribution of demographic, lifestyle, social and clinical factors as men without CVD, but higher medical morbidity. One hundred and twenty six (29.2%) men died and another 43 had a recorded diagnosis of depressive disorder between the baseline assessment and the 31st December 2007. Compared with participants without CVD, the adjusted hazard ratio of recurrent or persistent depression during follow up for participants with CVD was 0.78 (95% confidence interval, 95% CI=0.43-1.42). An additional 30 men were identified with depression during a new clinical assessment in 2008-09. Logistic regression showed that the adjusted odds of depression for men with compared to those without CVD was 0.98 (95% CI=0.61-1.59).

CONCLUSION

Persistence or recurrence of symptoms over 6 years in older men with depression is not influenced by the presence of CVD, which raises doubts about the usefulness and validity of the concept of vascular depression.

Towards automated detection of depression from brain structural magnetic resonance images

INTRODUCTION

Depression is a major issue worldwide and is seen as a significant health problem. Stigma and patient denial, clinical experience, time limitations, and reliability of psychometrics are barriers to the clinical diagnoses of depression. Thus, the establishment of an automated system that could detect such abnormalities would assist medical experts in their decision-making process. This paper reviews existing methods for the automated detection of depression from brain structural magnetic resonance images (sMRI).

METHODS

Relevant sources were identified from various databases and online sites using a combination of keywords and terms including depression, major depressive disorder, detection, classification, and MRI databases. Reference lists of chosen articles were further reviewed for associated publications.

RESULTS

The paper introduces a generic structure for representing and describing the methods developed for the detection of depression from sMRI of the brain. It consists of a number of components including acquisition and preprocessing, feature extraction, feature selection, and classification.

CONCLUSION

Automated sMRI-based detection methods have the potential to provide an objective measure of depression, hence improving the confidence level in the diagnosis and prognosis of depression.