The association of depressive symptoms with cardiovascular and all-cause mortality in Central and Eastern Europe: Prospective results of the HAPIEE study

Abstract

BackgroundStudies in western populations have shown a positive association between depression and cardiovascular disease (CVD) and all-cause mortality. The association with depressive symptoms seems to be graded, rather than limited to the presence versus the absence of depression. Evidence from populations with potentially different patterns of confounders helps to address the consistency of these findings. The objective of the study was to investigate the association between depressive symptoms and all-cause and CVD mortality in populations of Central and Eastern Europe.Study designThis was a prospective cohort study.MethodsA total of 24,542 participants aged 45–69 years, randomly selected from populations of Novosibirsk (Russia), Krakow (Poland) and six Czech towns, were included. Depressive symptoms, assessed by the 20-item Center for Epidemiologic Studies Depression (CES-D) scale, were used as both continuous and categorical variables. Data on deaths were obtained from local or national death registers. Associations between depression and mortality were assessed using Cox proportional hazards models.ResultsOver a median of 7 years, 2091 deaths from all causes and 850 CVD deaths occurred in the cohorts. There was a graded association between CES-D score and mortality; the hazard ratio (HR) of CVD mortality for a 1 SD increase in CES-D was 1.20 (95% confidence interval (CI): 1.16–1.24) in men and 1.23 (95% CI: 1.12–1.35) in women; for all-cause mortality, the HRs were 1.13 (95% CI: 1.09–1.18) and 1.17 (95% CI: 1.10–1.25), respectively. The results were similar across countries.ConclusionsDepressive symptoms predicted CVD and all-cause mortality independently of a wide range of potential confounders. The association followed a gradient and increased mortality risks were associated with scores below the cut-offs that are commonly used to define ‘depression’.

Depression and mortality in a longitudinal study: 1952–2011

“…3,4 In contrast, mortality risk over longer periods of time may be more likely to result from chronic conditions associated with depression. [5][6][7][8] The question of duration is also important, from a clinical perspective: a history of depression is a strong predictor of later recurrence, and according to long-term follow-up studies, as many as one-third of individuals with depression will have a chronic form of the disorder. [9][10][11] Any analysis of long-term elevations in mortality risk following depressive episodes should also consider secular trends, given broader changes in society; the past half-century has seen a reduction in the stigma associated with depression, an increased awareness of depression and the development of more tolerable and effective treatments for depression.…”

“…7,16 Addressing these gaps requires populationbased data on depression and subsequent mortality over a long period.…”

The Relation of Light-to-Moderate Alcohol Consumption to Glucose Metabolism and Insulin Resistance in Nondiabetic Adults: the Moderating Effects of Depressive Symptom Severity, Adiposity, and Sex

“…In contrast, women with mild-to-moderate levels of depressive symptoms failed to show a metabolic benefit of light-to-moderate alcohol consumption. Although novel, the results suggest that, in addition to its relation to cardiometabolic diseases (e.g., [32, 33]) and early risk markers [30, 34], elevated levels of depressive symptoms also play a role in inhibiting the health benefits of health-promoting behaviors such as light-to-moderate alcohol consumption. Such inhibitory actions point to a new role for elevated depressive symptoms as a factor that potentially modifies the health benefits of lifestyle factors such as light-to-moderate alcohol consumption and, as reported in our previous study, leisure time physical activity [16].…”

Efficacy of curcumin, and a saffron/curcumin combination for the treatment of major depression: A randomised, double-blind, placebo-controlled study

“…It is a disabling condition that has adverse effects on personal, social, occupational, and educational function. Depression is also associated with significant medical difficulties as there is a greater risk of mortality from all causes in people with depression compared to their non-depressed counterparts (Kozela et al, 2016). In fact, according to the World Health Organization (WHO, 2008), depression is the leading cause of disability as measured by Years Lived with a Disability and the fourth leading contributor to the global burden of disease.…”