Association of Depression and Anxiety With the 10-Year Risk of Cardiovascular Mortality in a Primary Care Population of Latvia Using the SCORE System

Abstract

Background: Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of cardiovascular (CV) diseases (CVD). The Systematic Coronary Risk Evaluation (SCORE) function measures the 10-year risk of a fatal CVD and is a crucial tool for guiding CV patient management. This study is the first in Latvia to investigate the association of depression and anxiety with the 10-year CV mortality risk in a primary care population.Methods: This cross-sectional study was conducted at 24 primary care facilities. During a 1-week period in 2015, all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by sociodemographic questionnaire and physical measurements. The diagnostic Mini International Neuropsychiatric Interview (M.I.N.I.) was administered by telephone in the period of 2 weeks after the first contact at the primary care facility. A hierarchical multivariate analysis was performed.Results: The study population consisted of 1,569 subjects. Depressive symptoms (PHQ-9 ≥10) were associated with a 1.57 (95% confidence interval (CI): 1.06–2.33) times higher odds of a very high CV mortality risk (SCORE ≥10%), but current anxiety disorder (M.I.N.I.) reduced the CV mortality risk with an odds ratio of 0.58 (95% CI: 0.38–0.90).Conclusions: Our findings suggest that individuals with SCORE ≥10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD. Anxiety could possibly have a protective influence on CV prognosis.

Prevalence of depression and anxiety and their association with cardiovascular risk factors in Northeast Brasil primary care patients

“…In addition, studies that related anxiety and depression disorders (ADD) and CVD in primary care centers suggest that depressive disorders could be associated with a very high risk of mortality from cardiovascular causes. 13 Despite the prevalence and importance of these conditions in primary care, the rates of identification and treatment remain very low, with less than half of the depressive episodes identified correctly. 14 The prevalence of depression in this population ranged from 21.4% to 31.0%, according to a Brazilian multicenter study conducted in four large cities.…”

Latvian Family Physicians’ Experience and Attitude in Diagnosing and Managing Depression

“…This information was used to develop diagnostic and treatment algorithms for depression in primary care in Latvia (Vrublevska et al, 2017;Rancans et al, 2018). Other studies suggested that patients with a Systematic COronary Risk Evaluation (SCORE) 10% could benefit from screening and early treatment of depression to potentially delay its development and improve the prognosis of cardiovascular disease (Ivanovs et al, 2018). However, while the doctors in our study were ready to introduce routine screening of depression in their practices, the US Preventive Services Task Force recommended against routine screening unless "staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment and follow-up".…”

The Relationship Between Mobility, Physical Activity and Strength with Depression, Cognitive State and Health Status in the Elderly in Portugal

“…Changes in older people's life, with a decreasing socialfamiliar support, loss of occupational status and decrease of social inclusion, are often a reason to trigger feelings of solitude and loneliness, leading to depressive states (Petitte et al, 2015). A state of good mental health is associated with better social networks (Ivanovs et al, 2018).…”

“…week (Ivanovs et al, 2018). 10 of the 30 items are scored with 1 point when the answer is "No" (items 1, 5, 7, 9, 15, 19, 21, 27, 29 and 30) and the other 20 are scored with 1 point when the answer is "Yes".…”

“…For an experiential point of view, the elderly experience continuous losses, such as decreasing socialfamiliar support, loss of occupational status, increasing frequency diseases and reduction in social inclusion, among others, resulting in an increase of dejection, which leads to feelings of loneliness, solitude and thereafter to depressive states (Petitte et al, 2015). Depression is considered as one of the primary causes of incapacity in the world and also one of the most prevailing conditions in the elderly population (Barret et al, 2011;Ivanovs et al, 2018). The presence of depressive symptoms has significant social implications and negative consequences to the individual's quality of life.…”