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Lu X, Liu C, Lu H, Qian X, Wang C, Jia C, Jia F. Eight-year total, cognitive-affective, and somatic depressive symptoms trajectories and risks of cardiac events. Transl Psychiatry 2024; 14:356. [PMID: 39231933 PMCID: PMC11374896 DOI: 10.1038/s41398-024-03063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/06/2024] Open
Abstract
In this study, we analyzed pooled data from two prospective population-based cohorts-the Health Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA)-to explore the association between trajectories of depressive symptoms and the risk of cardiac events. Depressive symptoms were assessed using the 8-item CES-D scale and categorized into somatic and cognitive-affective subtypes. Trajectories were tracked for four surveys from baseline. Heart disease was identified based on self-reported physician-diagnosed conditions. Hazard ratios and 95% confidence intervals were calculated with Cox proportional risk models that adjusted for potential confounders. In total, 17,787 subjects (59.7% female, median age 63 years) were enrolled at baseline. During a 10-year follow-up, 2409 cases of heart disease were identified. Participants with fluctuating (HR = 1.13, 95% CI: 1.06-1.20), increasing (HR = 1.43, 95% CI: 1.25-1.64), and consistently high (HR = 1.64, 95% CI: 1.45-1.84) depressive symptom trajectories exhibited an increased risk of heart disease compared to those with consistently low depressive symptoms, while a decreasing (HR = 1.07, 95% CI: 0.96-1.19) depressive symptom trajectory did not significantly affect the risk of heart disease. Moreover, the association between heart disease and somatic depressive symptoms was found to be stronger than with cognitive-affective symptoms. These findings suggest a significant link between depressive symptom trajectories and heart disease, with particular emphasis on stronger associations with somatic symptoms. It is recommended that the identification and management of depressive symptoms be incorporated into heart disease prevention strategies.
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Affiliation(s)
- Xinyi Lu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chunxiao Liu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hong Lu
- Department of Pharmacy, Yucheng City People's Hospital, Dezhou, Shandong, China
| | - Xiaoyu Qian
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Congdi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Feifei Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Chang JPC, Chang SS, Chen HT, Chien YC, Yang HT, Huang SY, Tseng PT, Chang CH, Galecki P, Su KP. Omega-3 polyunsaturated fatty acids (n-3 PUFAs), somatic and fatigue symptoms in cardiovascular diseases comorbid major depressive disorder (MDD): A randomized controlled trial. Brain Behav Immun 2023; 112:125-131. [PMID: 37301235 DOI: 10.1016/j.bbi.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVDs) and major depressive disorder (MDD) are the two most disabling diseases. Patients with CVDs comorbid depression had somatic and fatigue symptoms and were associated with chronic inflammation and omega-3 polyunsaturated fatty acid (n-3 PUFA) deficits. However, there have been limited studies on the effects of n-3 PUFAs on somatic and fatigue symptoms in patients with CVDs comorbid MDD. METHOD Forty patients with CVDs comorbid MDD (58% males, mean age of 60 ± 9 years) were enrolled and randomised to receive either n-3 PUFAs (2 g of eicosapentaenoic acid [EPA] and 1 g of docosahexaenoic acid[DHA] per day) or placebo in a 12-week double-blind clinical trial. We assessed the somatic symptoms with Neurotoxicity Rating Scale (NRS) and fatigue symptoms with Fatigue Scale at baseline, weeks 1, 2, 4, 8 and 12, as well as blood levels of Brain-Derived Neurotrophic Factor (BDNF), inflammatory biomarkers and PUFAs, at the baseline and week 12. RESULTS The n-3 PUFAs group had a greater reduction in Fatigue scores than the placebo group at Week 4 (p =.042), while there were no differences in the changes of NRS scores. N-3 PUFAs group also had a greater increase in EPA (p =.001) and a greater decrease in total n-6 PUFAs (p =.030). Moreover, in the subgroup analyses in the younger age group (age < 55), the n-3 PUFAs group had a greater reduction on NRS total scores at Week 12 (p =.012) and NRS Somatic scores at Week 2 (p =.010), Week 8 (p =.027), Week 12 (p =.012) than the placebo group. In addition, the pre- and post-treatment changes of EPA and total n-3 PUFAs levels were negatively associated with the changes of NRS scores at Weeks 2, 4, and 8 (all p <.05), and the changes of BDNF levels were negatively associated with NRS scores at Weeks 8 and 12 (both p <.05) in the younger age group. In the older age group (age ≥ 55), there were a lesser reduction on NRS scores at Weeks 1, 2 and 4 (all p <.05), but a greater reduction on Fatigue score at Week 4 (p =.026), compared to the placebo group. There was no significant correlation between the changes of blood BDNF, inflammation, PUFAs and NRS and Fatigue scores in general and in the older age group. CONCLUSION Overall, n-3 PUFAs improved the fatigue symptoms in patients with CVDs comorbid MDD and the general somatic symptoms in specific subpopulation of younger age patients, and perhaps via the interplay between BDNF and EPA. Our findings provide promising rationales for future studies to investigate the treatment effects of omega-3 fatty acids on fatigue and somatic symptoms of chronic mental and medical diseases.
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Affiliation(s)
- Jane Pei-Chen Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Sheng Chang
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hui-Ting Chen
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chuan Chien
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hui-Ting Yang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Shih-Yi Huang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Ping-Tao Tseng
- Institute of Precision Medicine, National Sun Yat-Sen University, Kaoshiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Cheng-Ho Chang
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Piotr Galecki
- Department of Adult Psychiatry, Medical University of Lodz, Lodz, Poland
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
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3
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Liao Y, Zhang H, Guo L, Fan B, Wang W, Teopiz KM, Lui LMW, Lee Y, Li L, Han X, Lu C, McIntyre RS. Impact of cognitive-affective and somatic symptoms in subthreshold depression transition in adults: Evidence from Depression Cohort in China (DCC). J Affect Disord 2022; 315:274-281. [PMID: 35952931 DOI: 10.1016/j.jad.2022.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Symptoms of subthreshold depression may differentially affect the illness transition. We examined the impact of cognitive-affective and somatic symptoms on different subthreshold depression transitions as well as risk factors influencing the aforementioned symptoms changes. METHODS Adults with subthreshold depression in the Depression Cohort in China were enrolled. Data collection was conducted at baseline, 6 and 12 months from 2019 to 2020. Cognitive-affective and somatic symptoms were assessed using the Patient Health Questionnaire-9. A total of 993 participants completed 12-month follow-up and were divided into persistent, intermittent and remission groups according to change in depressive symptoms. The longitudinal change of cognitive-affective and somatic symptoms in the three groups, as well as risk factors was analyzed using the generalized linear mixed-model. RESULTS There were 24.07 %, 34.04 % and 41.89 % of participants proceeding into persistent, intermittent and remission subthreshold depression groups, respectively. Cognitive-affective symptoms were the core symptoms for predicting the deterioration in persistent subthreshold depression (t = 2.48, P = 0.013), whereas somatic symptoms improved over time (t = -2.82, P = 0.005). Anxiety symptoms were the primary risk factors for worsening cognitive-affective symptoms (P < 0.001), following by insomnia symptoms, age, marital status, resilience and social functions. Somatic symptoms were affected by insomnia symptoms, anxiety symptoms and Body Mass Index successively. LIMITATIONS Major Depressive Episode was not explored in follow-up. CONCLUSION Cognitive-affective symptoms in subthreshold depression are at greater risk of illness deterioration. Future studies should endeavor to identify specific risk factors in different symptoms to forestall the transition from subthreshold to Major Depressive Disorder.
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Affiliation(s)
- Yuhua Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Huimin Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Kayla M Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - LingJiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, People's Republic of China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada
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Virzi NE, Krantz DS, Bittner VA, Merz CNB, Reis SE, Handberg EM, Pepine CJ, Vaccarino V, Rutledge T. Depression Symptom Patterns as Predictors of Metabolic Syndrome and Cardiac Events in Symptomatic Women with Suspected Myocardial Ischemia: The Women's Ischemia Syndrome Evaluation (WISE and WISE-CVD) Projects. HEART AND MIND 2022; 6:254-261. [PMID: 36994354 PMCID: PMC10047568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Background Ischemic heart disease (IHD) risk in women includes biomedical, behavioral, and psychosocial contributors. The purpose of this study was to build upon previous research suggesting that in women, somatic symptoms (SS) of depression may be important to the development of IHD risk factors and major adverse cardiovascular events (MACE). Based on previous findings, we hypothesized that: (1) SS would be associated with robust biomedical predictors of heart disease and functional capacity, while cognitive symptoms (CS) of depression would not, and (2) SS would independently predict adverse health outcomes while CS would not. Methods We examined the relationships between symptoms of depression (SS/CS), metabolic syndrome (MetS), inflammatory markers (IM), coronary artery disease (CAD) severity, and functional capacity in two independent cohorts of women with suspected IHD. In the Women's Ischemia Syndrome Evaluation (WISE), we also examined these variables as predictors of all-cause mortality (ACM) + MACE over a median 9.3-year follow-up. The WISE sample included 641 women with suspected ischemia with or without obstructive CAD. The WISE-Coronary Vascular Dysfunction (WISE-CVD) sample consisted of 359 women with suspected ischemia and no obstructive CAD. All study measures were collected uniformly at baseline. Depressive symptoms were measured via the Beck Depression Inventory. MetS was assessed according to Adult Treatment Panel III (ATP-III) criteria. Results In both studies, SS was associated with MetS (Cohen's d = 0.18, 0.26, P < 0.05, respectively), while CS was not. Within WISE, using Cox Proportional Hazard Regression, SS (Hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 1.01-1.15; HR = 1.07, 95% CI = 1.00-1.13) and MetS (HR = 1.89, 95% CI = 1.16-3.08; HR = 1.74, 95% CI=1.07-2.84) were independent predictors of ACM + MACE after controlling for demographics, IM, and CAD severity, while CS was not. Conclusions In two independent samples of women undergoing coronary angiography due to suspected ischemia, SS but not CS of depression were associated with MetS, and both SS and MetS independently predicted ACM and MACE. These results add to previous studies suggesting that SS of depression may warrant specific attention in women with elevated cardiovascular disease (CVD) risk. Future research evaluating the biobehavioral basis of the relationship between depression, MetS, and CVD is needed.
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Affiliation(s)
- Nicole E. Virzi
- Department of Clinical Psychology, San Diego State University/University of California, San Diego Joint Doctoral Program, San Diego, California
| | - David S. Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland
| | - Vera A. Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
| | - Steven E. Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eileen M. Handberg
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Carl J. Pepine
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
| | - Thomas Rutledge
- Psychology Service, VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California, USA
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Zhang WY, Nan N, He Y, Zuo HJ, Song XT, Zhang M, Zhou Y. Prevalence of depression and anxiety symptoms and their associations with cardiovascular risk factors in coronary patients. PSYCHOL HEALTH MED 2022; 28:1275-1287. [PMID: 35880259 DOI: 10.1080/13548506.2022.2104885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study aimed to assess the prevalence of depression and anxiety in CHD patients and to explore the association between established cardiovascular risk factors and depression as well as anxiety. 2,216 patients with CHD confirmed by angiography were included in this cross-sectional study. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety symptoms. The frequencies of individual depressive and anxiety symptoms grouped by age and gender were analyzed. Binary logistic regression analyses were used to identify cardiovascular risk factors associated with anxiety and depression. The overall prevalence rates of depression and anxiety in CHD patients were 8.2% and 5.4%, respectively. There were significant differences in the frequency of depression and anxiety symptoms between genders. However, age differences among individual depression and anxiety symptoms were insignificant. In multivariable analysis, female gender, smoking, and hyperlipidemia were associated with a more frequent depression occurrence, and female gender was associated with more frequent anxiety. Depression and anxiety were not associated with other cardiovascular risk factors. These findings suggest that a substantial proportion of CHD patients experienced anxiety and depression symptoms. Differences in depressive or anxiety symptoms among the distribution of individual symptoms need more attention. Depression was significantly associated with female gender, smoking, and hyperlipidemia. No anxiety symptom associations with cardiovascular risk factors were demonstrated to be significant except for the female. More research is needed to unravel the mechanisms of depression, anxiety, and cardiovascular disease.
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Affiliation(s)
- Wen-Yi Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui-Juan Zuo
- Department of Community Health Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xian-Tao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yuan Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Lei J, Luo Y, Xie Y, Wang X. Visceral Adiposity Index Is a Measure of the Likelihood of Developing Depression Among Adults in the United States. Front Psychol 2022; 13:772556. [PMID: 35401344 PMCID: PMC8991090 DOI: 10.3389/fpsyg.2022.772556] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Depression is a serious mental disorder often accompanied by emotional and physiological disorders. Visceral fat index (VAI) is the current standard method in the evaluation of visceral fat deposition. In this study, we explored the association between VAI and depression in the American population using NHANES data. Methods A total of 2,577 patients were enrolled for this study. Data were collected through structured questionnaires. Subgroup analysis for the relationship between VAI and depression was evaluated using multivariate regression analysis after adjustment for potential confounding factors. Results For every 1 unit increase in VAI, the clinical depression increased by 14% (OR = 1.14, 95% CI: 1.04–1.25). High VAI scores (T3) increased the highest risk of developing depression (OR = 2.32, 95% CI: 1.2–4.47). Subgroup analysis demonstrated a strong and stable association between VAI and the development of depression. Conclusion Our study showed that depressive symptoms are associated with a high ratio of visceral adiposity index after controlling confounding factors.
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Affiliation(s)
- Jun Lei
- School of Nursing Hunan University of Chinese Medicine, Changsha, China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yaoyue Luo
- School of Nursing Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Yaoyue Luo,
| | - Yude Xie
- School of Nursing Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoju Wang
- College of Integrated Traditional Chinese and Western Medicine, Changsha, China
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Zhang L, Bao Y, Tao S, Zhao Y, Liu M. The association between cardiovascular drugs and depression/anxiety in patients with cardiovascular disease: A meta-analysis. Pharmacol Res 2021; 175:106024. [PMID: 34890773 DOI: 10.1016/j.phrs.2021.106024] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/27/2021] [Accepted: 12/05/2021] [Indexed: 12/26/2022]
Abstract
This study aimed to investigate the association between cardiovascular drugs and depression/anxiety in patients with cardiovascular disease (CVD). This meta-analysis was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42020197839) and conducted in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. The PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were systematically searched to identify all available studies on this topic. Random-effects multivariate meta-regression was performed to investigate the sources of study heterogeneity. Review Manager version 5.3 and Stata 12.0 were used for data analyses. This meta-analysis included 54 studies with a total number of 212,640 patients. Overall, in patients with CVD, aspirin (odds ratio [OR]:0.91, 95% confidence interval [CI]:0.86-0.96, P = 0.02) was associated with a lower risk of depression, while calcium channel blockers (CCB) (OR:1.21, 95%CI:1.05-1.38, P = 0.008), diuretics (OR:1.34, 95%CI:1.14-1.58, P = 0.0005), and nitrate esters (OR:1.32, 95%CI:1.08-1.61, P = 0.006) were associated with a higher risk of depression, additionally, statin (OR:0.79, 95%CI:0.71-0.88, P < 0.0001) was associated with a lower risk of anxiety, but diuretics (OR:1.39, 95%CI:1.26-1.52, P < 0.00001) was associated with a higher risk of anxiety. Subgroup analysis presented that, in patients with hypertension, β-blockers were associated with a higher risk of depression (OR:1.45, 95%CI:1.26-1.67, P < 0.00001); in patients with coronary artery disease (CAD), statin (OR:0.77, 95%CI:0.59-0.99, P = 0.04), and aspirin (OR:0.85, 95%CI:0.75-0.97, P = 0.02) were associated with a lower risk of depression, while CCB (OR:1.32, 95%CI:1.15-1.51, P < 0.0001) and diuretics (OR:1.36, 95%CI:1.12-1.64, P = 0.002) were associated with a higher risk of depression, additionally, diuretics was associated with a higher risk of anxiety (OR:1.41, 95%CI:1.28-1.55, P < 0.00001); in patients with heart failure, nitrate esters (OR:1.93, 95%CI:1.19-3.13, P = 0.007), and diuretics (OR:1.58, 95%CI: 1.02-2.43, P = 0.04) were associated with a higher risk of depression. The use of cardiovascular drugs should be considered when evaluating depression or anxiety in patients with CVD to improve the care and treatment of these patients.
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Affiliation(s)
- Lijun Zhang
- Department of Psycho-cardiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China.
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China.
| | - Shuhui Tao
- Department of Psycho-cardiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China; School of Basic Medical Sciences, Henan University, Kaifeng, China.
| | - Yimiao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China.
| | - Meiyan Liu
- Department of Psycho-cardiology, Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing 100029, China.
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Norton J, Pastore M, Ancelin M, Hotopf M, Tylee A, Mann A, Palacios J. Time-dependent cognitive and somatic symptoms of depression as predictors of new cardiac-related events in at-risk patients: the UPBEAT-UK cohort. Psychol Med 2021; 51:1271-1278. [PMID: 31996279 DOI: 10.1017/s0033291719004082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence suggests that somatic rather than cognitive depressive symptoms are risk factors for recurrent cardiac events in at-risk patients. However, this has never been explored using a time-dependent approach in a narrow time-frame, allowing a cardiac event-free time-window. METHODS The analysis was performed on 595 participants [70.6% male, median age 72 (27-98)] drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Depressive symptomatology was measured using the Patient Health Questionnaire-9 (PHQ-9) (four somatic, five cognitive items). New cardiac events (NCEs) including cardiac-related mortality were identified by expert examination of patient records. Analyses were performed using Cox proportional hazard models with delayed entry, with time-dependent depressive dimensions and covariates measured 12-18 months (median: 14.1, IQR: 3.5) prior to the event, with a 12-month cardiac event-free gap. RESULTS There were 95 NCEs during the follow-up [median time-to-event from baseline: 22.3 months (IQR: 13.4)]. Both the somatic (HR 1.12, 95% CI 1.05-1.20, p = 0.001) and cognitive dimensions (HR 1.11, 95% CI 1.03-1.18, p = 0.004) were time-dependent risk factors for an NCE in the multi-adjusted models. Specific symptoms (poor appetite/overeating for the somatic dimension, hopelessness and feeling like a failure for the cognitive dimension) were also significantly associated. CONCLUSION This is the first study of the association between depressive symptom dimensions and NCEs in at-risk patients using a time-to-event standardised approach. Both dimensions considered apart were independent predictors of an NCE, along with specific items, suggesting regular assessments and tailored interventions targeting specific depressive symptoms may help to prevent NCEs in at-risk populations.
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Affiliation(s)
- J Norton
- Inserm U1061, Montpellier, France
- University of Montpellier, Montpellier, France
| | - M Pastore
- University of Montpellier, Montpellier, France
- StatABio, CNRS, INSERM, Montpellier, France
| | - M Ancelin
- Inserm U1061, Montpellier, France
- University of Montpellier, Montpellier, France
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - A Tylee
- Department of Health Services and Population Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Mann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Palacios
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Patel JS, Oh Y, Rand KL, Wu W, Cyders MA, Kroenke K, Stewart JC. Measurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005-2016. Depress Anxiety 2019; 36:813-823. [PMID: 31356710 PMCID: PMC6736700 DOI: 10.1002/da.22940] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite its popularity, little is known about the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9) across U.S. sociodemographic groups. Use of a screener shown not to possess measurement invariance could result in under/over-detection of depression, potentially exacerbating sociodemographic disparities in depression. Therefore, we assessed the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups. METHODS U.S. population representative data came from the 2005-2016 National Health and Nutrition Examination Survey (NHANES) cohorts. We conducted a measurement invariance analysis of 31,366 respondents across sociodemographic factors of sex, race/ethnicity, and education level. RESULTS Considering results of single-group confirmatory factor analyses (CFAs), depression theory, and research utility, we justify a two-factor structure for the PHQ-9 consisting of a cognitive/affective factor and a somatic factor (RMSEA = 0.034, TLI = 0.985, CFI = 0.989). On the basis of multiple-group CFAs testing configural, scalar, and strict factorial invariance, we determined that invariance held for sex, race/ethnicity, and education level groups, as all models demonstrated close model fit (RMSEA = 0.025-0.025, TLI = 0.985-0.992, CFI = 0.986-0.991). Finally, for all steps ΔCFI was <-0.004, and ΔRMSEA was <0.01. CONCLUSIONS We demonstrate that the PHQ-9 is acceptable to use in major U.S. sociodemographic groups and allows for meaningful comparisons in total, cognitive/affective, and somatic depressive symptoms across these groups, extending its use to the community. This knowledge is timely as medicine moves towards alternative payment models emphasizing high-quality and cost-efficient care, which will likely incentivize behavioral and population health efforts. We also provide a consistent, evidence-based approach for calculating PHQ-9 subscale scores.
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Affiliation(s)
- Jay S. Patel
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Youngha Oh
- Educational Psychology, Research, Evaluation, Measurement, and Statistics (REMS), Texas Tech University, Lubbock, TX
| | - Kevin L. Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Melissa A. Cyders
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Indianapolis, IN
| | - Jesse C. Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
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10
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Reichardt LA, van Seben R, Aarden JJ, van der Esch M, van der Schaaf M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Trajectories of cognitive-affective depressive symptoms in acutely hospitalized older adults: The hospital-ADL study. J Psychosom Res 2019; 120:66-73. [PMID: 30929710 DOI: 10.1016/j.jpsychores.2019.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify trajectories of cognitive-affective depressive symptoms among acutely hospitalized older patients and whether trajectories are related to prognostic baseline factors and three-month outcomes such as functional decline, falls, unplanned readmissions, and mortality. METHODS Prospective multicenter cohort of acutely hospitalized patients aged ≥ 70. Depressive trajectories were based on Group Based Trajectory Modeling, using the Geriatric Depression Scale-15. Outcomes were functional decline, falls, unplanned readmission, and mortality within three months post-discharge. RESULTS The analytic sample included 398 patients (mean age = 79.6 years; SD = 6.6). Three distinct depressive symptoms trajectories were identified: minimal (63.6%), mild persistent (25.4%), and severe persistent (11.0%). Unadjusted results showed that, compared to the minimal symptoms group, the mild and severe persistent groups showed a significantly higher risk of functional decline (mild: OR = 3.9, p < .001; severe: OR = 3.0, p = .04), falls (mild: OR = 2.0, p = .02; severe: OR = 6.0, p < .001), and mortality (mild: OR = 2.2, p = .05; severe: OR = 3.4, p = .009). Patients with mild or severe persistent symptoms were more malnourished, anxious, and functionally limited and had more medical comorbidities at admission. CONCLUSION Nearly 40% of the acutely hospitalized older adults exhibited mild to severe levels of cognitive-affective depressive symptoms. In light of the substantially elevated risk of serious complications and the fact that elevated depressive symptoms was not a transient phenomenon identification of these patients is needed. This further emphasizes the need for acute care hospitals, as a point of engagement with older adults, to develop discharge or screening procedures for managing cognitive-affective depressive symptoms.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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11
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Jeong S, Kang C, Cho H, Kang HJ, Jang S. Socioeconomic determinants affecting the access and utilization of depression care services in immigrants: A population-based study. PLoS One 2019; 14:e0213020. [PMID: 30865684 PMCID: PMC6415893 DOI: 10.1371/journal.pone.0213020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 02/13/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is imperative to address the health problems faced by immigrants in their destination countries in light of the current magnitude of migration processes worldwide. We aimed to evaluate the socioeconomic determinants of healthcare utilization in immigrants with depression. METHOD A population-based cohort comprising all immigrants who were eligible for National Health Insurance coverage (permanent residents, marriage immigrants, and naturalized citizens) using the National Health Insurance Claims Database in 2011-2013 was established. Cases were defined as immigrants with new-onset depression. Controls were new-onset Korean patients with depression matched by age, sex, and Charlson comorbidity index in a 1:2 ratio. Appropriateness of care (AOC) was defined as visiting a clinic for depression management at least 3 times in the first 12 weeks and 4 times thereafter until 12 months post-cohort entry. RESULTS A total of 2,378 immigrants and 4,756 matched Korean patients were identified. Of the immigrants, 30.0% achieved AOC, in contrast to 38.7% of Koreans (p < .0001). Adjusting for possible covariates, AOC was less likely for immigrants (adjusted OR (aOR), 0.760; 95% CI: 0.670-0.863). Medical Aid (aOR, 2.309; 95% CI, 1.479-3.610), rural residence (aOR, 1.536; 95% CI, 1.054-2.237), the presence of a psychiatric comorbidity (aOR, 1.912; 95% CI, 1.484-2.463), and visiting a psychiatrist (aOR, 2.387; 95% CI, 1.821-3.125) were associated with an increased likelihood of AOC in immigrants. CONCLUSION Socioeconomic determinants included insurance type (Medical Aid and National Health Insurance), place of residence, psychiatric comorbid status, doctor specialty, easy access to medical services (clinic-based), and a SSRI-based treatment regimen. Those predictors should be taken into account when developing healthcare strategies for immigrants.
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Affiliation(s)
- Sohyun Jeong
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Cinoo Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Hee-Jin Kang
- Big Data Steering Department of National Health Insurance Service, Wonju, Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
- * E-mail:
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12
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Yin H, Liu Y, Ma H, Liu G, Guo L, Geng Q. Associations of mood symptoms with NYHA functional classes in angina pectoris patients: a cross-sectional study. BMC Psychiatry 2019; 19:85. [PMID: 30836983 PMCID: PMC6402172 DOI: 10.1186/s12888-019-2061-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/18/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Depression and anxiety are prevalent and associated with a worse prognosis in coronary heart disease (CHD) patients. However, the influence of disease severity on mood symptoms is unknown. The specific associations of mood symptoms with NYHA classes remain unexplored. METHODS In this cross-sectional study, 443 consecutive inpatients with angina pectoris (AP) confirmed by angiography were included into analysis. Somatic and cognitive symptom scores derived from Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess mood symptoms. Predictors for depression and anxiety with strict and lax standards were compared. We hypothesized NYHA classification to be an indicator of disease severity through analyses with clinical features using ordinal logistic model. Applying both binary and ordinal logistic models, we evaluated the associations of mood symptoms with NYHA classes. RESULTS Discrepancy of disease severity existed between the depressed and nondepressed. NYHA classification was proved to be an integrated index under influence of age, coronary stenosis, heart failure and diabetes. NYHA class I and II individuals with AP were at equivalent risk for depression (NYHA II vs I: binary model OR 1.32 (0.59,2.96), p = 0.50; ordinal model OR 1.17 (0.73,1.88), p = 0.52), however NYHA class III/IV patients shared a sharply higher risk (NYHA III/IV vs I: binary model OR 3.32 (1.28,8.61), p = .013; ordinal model OR 3.94 (2.11,7.36), p < .001). Analyses on somatic and cognitive depressive symptoms confirmed this finding and hinted a greater impact of education background on mood when patient's condition is unstable. Anxiety seemed in the whole picture irrelevant with NYHA classes. Comparing with NYHA class I/II, AP patients in NYHA class III/IV tended to be less anxious. However, when CHD became unstable, the calmness may immediately be broken up. A great distinction of the ratio of anxiety and depression symptom scores between NYHA class III/IV stable and unstable AP patients (p = .018) was observed. CONCLUSIONS Mood symptoms in CHD patients are to a great extend derived from disease itself. Only for patients with relatively serious physical condition, unexpected discomforts caused by disease notably impact the emotions. Education background tends to influence the mood especially when disease is still unstable.
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Affiliation(s)
- Han Yin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,0000 0004 1764 3838grid.79703.3aSchool of Medicine, South China University of Technology, Guangzhou, China
| | - Yuting Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,0000 0004 1764 3838grid.79703.3aSchool of Medicine, South China University of Technology, Guangzhou, China
| | - Huan Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China
| | - Guihao Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lan Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China. .,School of Medicine, South China University of Technology, Guangzhou, China.
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13
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Deter HC, Weber C, Herrmann-Lingen C, Albus C, Juenger J, Ladwig KH, Soellner W, de Zwaan M, Hellmich M, Grün AS, Ronel J, Orth-Gomér K. Gender differences in psychosocial outcomes of psychotherapy trial in patients with depression and coronary artery disease. J Psychosom Res 2018; 113:89-99. [PMID: 30190055 DOI: 10.1016/j.jpsychores.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The biological and psychosocial risk profile differs between women and men with coronary artery disease (CAD). Depressive symptoms and Vital Exhaustion (VE) predict an unfavourable course of CAD. The secondary analysis of the SPIRR-CAD trial offered the possibility to examine gender as exposure variable of the clinical and psychological situation at baseline and in a variety of psychosocial measures as outcomes. METHODS In this trial, 450 men (78.9%) and 120 women (21.1%) with CAD (age ≤ 75 y), with mild to moderate depression (scoring ≥8 on the HADS), were randomized to usual care with or without a stepwise psychotherapy intervention. Beside clinical measures exhaustion and other indicators of depressive symptoms were collected at baseline and 18-month follow up. RESULTS Men had more signs and symptoms of heart disease at baseline, whereas women had higher psychosocial burden (e.g. negative affect). Women were more likely to live alone, had lower educational levels and employment rates and higher levels of depression and exhaustion. The psychotherapy intervention differed as a function of gender: In women, VE decreased from 29.4 ± 8.1 to 22.1 ± 11.7 in the intervention group (IG) and from 29.2 ± 8.2 to 25.1 ± 11.3 in the control group (CG). In men VE decreased from 23.3 + -10.8 to 21.2 ± 9.7 in the IG and from 23.6 ± 10.7 to 19.3 ± 11.3 in the CG (time x intervention x gender; F = 4.97; p = .026). DISCUSSION Women had a higher psychosocial burden than men. VE compared to other rating instruments of depressive symptoms suggested a stronger response to the intervention in women. VE may help to understand gender differences in psychotherapeutic treatment studies of CAD. ISRCTN 76240576; clinicaltrials.gov.
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Affiliation(s)
- Hans-Christian Deter
- Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany.
| | - Cora Weber
- Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Christoph Herrmann-Lingen
- Dept. of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Goettingen, Germany
| | - Christian Albus
- Dept. of Psychosomatics and Psychotherapy, University of Cologne, Germany
| | - Jana Juenger
- Dept. of General Internal and Psychosomatic Medicine, University of Heidelberg, Germany
| | - Karl-Heinz Ladwig
- GSF- National Research Center for Environment and Health, Institute of Epidemiology, Munich-Neuherberg and Institute and Dept. of Psychosomatic Medicine, Psychotherapy and Medical Psychology, Technical Univ. of Munich, Klinikum rechts der Isar, Germany
| | - Wolfgang Soellner
- Dep. of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Germany
| | - Martina de Zwaan
- Dept. of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany
| | - Martin Hellmich
- Institut of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - Anna-Sophia Grün
- Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Joram Ronel
- Institute and Dept. of Psychosomatic Medicine, Psychotherapy and Medical Psychology, Technical Univ. of Munich, Klinikum rechts der Isar, Germany
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Bangalore S, Shah R, Pappadopulos E, Deshpande CG, Shelbaya A, Prieto R, Stephens J, McIntyre RS. Cardiovascular hazards of insufficient treatment of depression among patients with known cardiovascular disease: a propensity score adjusted analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 4:258-266. [DOI: 10.1093/ehjqcco/qcy023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/06/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Sripal Bangalore
- Cardiovascular Outcomes Group, Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, SKI 9R/109, New York, NY, USA
| | - Ruchitbhai Shah
- Pharmerit International, LP, 4350 East West Hwy, Suite #1110, Bethesda, MD, USA
| | | | - Chinmay G Deshpande
- Pharmerit International, LP, 4350 East West Hwy, Suite #1110, Bethesda, MD, USA
| | - Ahmed Shelbaya
- Pfizer Inc., 235 E 42nd St, New York, NY, USA
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, USA
| | - Rita Prieto
- Pfizer GEP, S.L.U., AVENIDA DE EUROPA (PQ EMP LA MORALEJA), 20 - B, ALCOBENDAS, MADRID, Spain
| | - Jennifer Stephens
- Pharmerit International, LP, 4350 East West Hwy, Suite #1110, Bethesda, MD, USA
| | - Roger S McIntyre
- MDPU, UHN University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, Ontario, Canada
- Brain and Cognition Discovery Foundation, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, Ontario, Canada
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15
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Wiltink J, Michal M, Jünger C, Münzel T, Wild PS, Lackner KJ, Blettner M, Pfeiffer N, Brähler E, Beutel ME. Associations between degree and sub-dimensions of depression and metabolic syndrome (MetS) in the community: results from the Gutenberg Health Study (GHS). BMC Psychiatry 2018; 18:114. [PMID: 29699530 PMCID: PMC5921368 DOI: 10.1186/s12888-018-1691-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/16/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A growing number of studies have associated metabolic syndrome (MetS) and depression, both retrospectively and prospectively. However, it has remained unclear, which degrees, or sub-dimensions of depression are related to MetS and if comorbid depression affects health care utilization. The purpose of the study was to determine the associations of a) somatic and cognitive-affective symptoms to MetS and b) depression and MetS to health care utilization. METHODS In a population-based, representative survey of 14.499 participants we studied the associations of the two dimensions of depression with MetS and health care utilization. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9). RESULTS MetS and its components were associated with the degree of depression, particularly with moderately severe/ severe depressive symptoms (PHQ-9 > = 15). There were clear positive associations of somatic-affective depressive symptoms with the presence of MetS and its components. Cognitive-affective symptoms were negatively associated with MetS. At the single item level, disorders of sleep and appetite as well as exhaustion were positively, while trouble concentrating was negatively associated with MetS. Symptoms of depression were related to higher consultations of somatic and mental health care, while the presence of MetS was related to somatic health care utilization. There was an additional interaction of depressive symptoms and MetS with mental health care. CONCLUSIONS Somatic affective symptoms of depression are positively associated, while cognitive-affective symptoms are negatively associated with MetS.
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Affiliation(s)
- Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Matthias Michal
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Claus Jünger
- grid.410607.4Center of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- grid.410607.4Center of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S. Wild
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany ,grid.410607.4Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany ,0000 0004 5937 5237grid.452396.fDZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany
| | - Karl J. Lackner
- grid.410607.4Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Blettner
- grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- grid.410607.4Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Elmar Brähler
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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AbuRuz ME, Alaloul F, Al-Dweik G. Depressive symptoms are associated with in-hospital complications following acute myocardial infarction. Appl Nurs Res 2018; 39:65-70. [DOI: 10.1016/j.apnr.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 08/13/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022]
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17
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Tolentino JC, Schmidt SL. DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry 2018; 9:450. [PMID: 30333763 PMCID: PMC6176119 DOI: 10.3389/fpsyt.2018.00450] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/30/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Depression diagnosis requires five or more symptoms (Diagnostic and Statistical Manual of Mental Disorders-DSM-5). One of them must be either Depressed mood or Anhedonia, named main criteria. Although the secondary symptoms can be divided into somatic and non-somatic clusters, the DSM-5 identify depression in all or none fashion. In contrast, depression severity is a continuous variable. Therefore, it is commonly assessed with scales such as the Hamilton Depression Rating Scale (HAMD). Previously, we reported that patients with moderate depression (MD) exhibit greater impairments in cardiac-autonomic modulation than severely depressed (SD) patients. However, clinicians usually do not use scales. Objective: To verify whether the DSM-5 symptoms would be able to discriminate SD from MD and MD from non-depressed (ND) subjects. Material and Methods: Depression was diagnosed based on the Structured Clinical Interview for DSM-5® Disorders. The HAMD evaluated depression severity. In depressed subjects, MD and SD were defined considering the HAMD scores. ND was defined considering both the absence of DSM-5 criteria for depression and the HAMD score. Among 782 outpatients, 46 SD were found. MD and ND subjects were randomly sampled to match the demographic variables of the SD group. Results: Discriminant analysis showed that Depressed Mood was the most reliable symptom to discriminate ND from MD. Anhedonia discriminated SD from MD. Among the secondary DSM-5 criteria, the somatic cluster discriminated ND from MD and the non-somatic cluster SD from MD patients. Discussion: The presence of the somatic cluster in MD may indicate decreased vagal tone and/or increased sympathetic tone, leading to higher cardiovascular risk. As SD is associated with the non-somatic cluster, these patients are at risk of committing suicide. The DSM-5 symptoms exhibited by the patient may help the choice of adequate pharmacological treatment. This would avoid the use of antidepressants that unnecessarily increase cardiac risk in MD. When the symptom cluster suggests SD, the treatment must focus on the prevention of suicide. Conclusions: Depression severity may be inferred based on the DSM-5 criteria. The presence of the Anhedonia main criterium accompanied by non-somatic criteria indicate SD. The Depressive Mood criterium followed by somatic criteria suggest MD.
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Affiliation(s)
- Julio C Tolentino
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio L Schmidt
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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18
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Chirinos DA, Gurubhagavatula I, Broderick P, Chirinos JA, Teff K, Wadden T, Maislin G, Saif H, Chittams J, Cassidy C, Hanlon AL, Pack AI. Depressive symptoms in patients with obstructive sleep apnea: biological mechanistic pathways. J Behav Med 2017; 40:955-963. [PMID: 28639107 PMCID: PMC9926999 DOI: 10.1007/s10865-017-9869-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 06/16/2017] [Indexed: 12/30/2022]
Abstract
This study examined the association between depressive symptoms, as well as depressive symptom dimensions, and three candidate biological pathways linking them to Obstructive sleep apnea (OSA): (1) inflammation; (2) circulating leptin; and (3) intermittent hypoxemia. Participants included 181 obese adults with moderate-to-severe OSA enrolled in the Cardiovascular Consequences of Sleep Apnea (COSA) trial. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II). We assessed inflammation using C-reactive protein levels (CRP), circulating leptin by radioimmunoassay using a double antibody/PEG assay, and intermittent hypoxemia by the percentage of sleep time each patient had below 90% oxyhemoglobin saturation. We found no significant associations between BDI-II total or cognitive scores and CRP, leptin, or percentage of sleep time below 90% oxyhemoglobin saturation after controlling for relevant confounding factors. Somatic symptoms, however, were positively associated with percentage of sleep time below 90% saturation (β = 0.202, P = 0.032), but not with CRP or circulating leptin in adjusted models. Another significant predictor of depressive symptoms included sleep efficiency (βBDI Total = -0.230, P = 0.003; βcognitive = -0.173, P = 0.030 (βsomatic = -0.255, P = 0.001). In patients with moderate-to-severe OSA, intermittent hypoxia may play a role in somatic rather than cognitive or total depressive symptoms.
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Affiliation(s)
| | - Indira Gurubhagavatula
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA.,Philadelphia VA Medical Center. Philadelphia, PA
| | - Preston Broderick
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Julio A Chirinos
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA.,Philadelphia VA Medical Center. Philadelphia, PA
| | - Karen Teff
- Monell Chemical Senses Center, Philadelphia, PA
| | - Thomas Wadden
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Greg Maislin
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | | | - Jesse Chittams
- University of Pennsylvania, School of Nursing. Philadelphia, PA
| | - Caitlin Cassidy
- LaSalle University, Department of Psychology, Philadelphia, PA
| | | | - Allan I. Pack
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
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Does the presence of multiple sclerosis impact on symptom profile in depressed patients? J Psychosom Res 2017; 103:70-76. [PMID: 29167049 DOI: 10.1016/j.jpsychores.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/29/2017] [Accepted: 10/11/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Major depressive disorder (MDD) is common in patients with multiple sclerosis (MS) but may remain unrecognized because of overlapping symptoms and different presentation due to its specific MS-related neurobiological aetiology. We aimed to investigate the clinical profile of MDD in MS. METHODS In a sample of MDD patients with MS (n=83) and without MS (n=782), MDD characteristics, 30 depressive symptoms, and sum scores of cognitive, somatic, atypical and melancholic symptom clusters were compared using logistic regression analyses and analysis of co-variance. RESULTS MDD in MS was characterized by older age of onset (p<0.001), and fewer comorbid anxiety disorders (37% versus 72%; p<0.001). The symptom 'future pessimism' was more common in MS patients (OR=1.62; 95%CI=1.02-2.59). 'Diminished capacity for pleasure/enjoyment' (OR=0.44; 95%CI=0.24-0.78), 'increased appetite' (OR=0.40; 95%CI=0.19-0.85), 'arousal symptoms' (OR=0.49; 95%CI=0.28-0.84), and 'panic/phobic symptoms' (OR=0.49; 95%CI=0.29-0.84) were less common in MS patients. Twenty-five symptoms (83%) out of 30, including depression's core symptoms (sadness and loss of interest) were not differentially associated with MS and no differences existed for the symptom clusters. CONCLUSION Only subtle differences in depressive symptom profiles existed between MDD patients with and without MS. The clinical profile of depression remains valid among MS patients, although it presents with diminished anxiety distress and comorbidity.
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The Relationship of Depressive Symptoms and Vitamin D Intake to Cardiac Event–Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 2017; 32:480-487. [DOI: 10.1097/jcn.0000000000000369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Carroll AJ, Auer R, Colangelo LA, Carnethon MR, Jacobs DR, Stewart JC, Widome R, Carr JJ, Liu K, Hitsman B. Association of the Interaction Between Smoking and Depressive Symptom Clusters With Coronary Artery Calcification: The CARDIA Study. J Dual Diagn 2017; 13:43-51. [PMID: 28129086 PMCID: PMC5525054 DOI: 10.1080/15504263.2017.1287455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Depressive symptom clusters are differentially associated with prognosis among patients with cardiovascular disease (CVD). Few studies have prospectively evaluated the association between depressive symptom clusters and risk of CVD. Previously, we observed that smoking and global depressive symptoms were synergistically associated with coronary artery calcification (CAC). The purpose of this study was to determine whether the smoking by depressive symptoms interaction, measured cumulatively over 25 years, differed by depressive symptom cluster (negative affect, anhedonia, and somatic symptoms) in association with CAC. METHODS Participants (N = 3,189: 54.5% female; 51.5% Black; average age = 50.1 years) were followed from 1985-1986 through 2010-2011 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking exposure was measured by cumulative cigarette pack-years (cigarette packs smoked per day × number of years smoking; year 0 through year 25). Depressive symptoms were measured using a 14-item, 3-factor (negative affect, anhedonia, somatic symptoms) model of the Center for Epidemiologic Studies Depression (CES-D) Scale (years 5, 10, 15, 20, and 25). CAC was assessed at year 25. Logistic regression models were used to evaluate the association between the smoking by depressive symptom clusters interactions with CAC ( = 0 vs. > 0), adjusted for CVD-related sociodemographic, behavioral, and clinical covariates. RESULTS 907 participants (28% of the sample) had CAC > 0 at year 25. The depressive symptom clusters did not differ significantly between the two groups. Only the cumulative somatic symptom cluster by cumulative smoking exposure interaction was significantly associated with CAC > 0 at year 25 (p = .028). Specifically, adults with elevated somatic symptoms (score 9 out of 18) who had 10, 20, or 30 pack-years of smoking exposure had respective odds ratios (95% confidence intervals) of 2.06 [1.08, 3.93], 3.71 [1.81, 7.57], and 6.68 [2.87, 15.53], ps < .05. Negative affect and anhedonia did not significantly interact with smoking exposure associated with CAC >0, ps > .05. CONCLUSIONS Somatic symptoms appear to be a particularly relevant cluster of depressive symptomatology in the relationship between smoking and CVD risk.
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Affiliation(s)
- Allison J. Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Reto Auer
- Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Laura A. Colangelo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis MN, USA
| | - Jesse C. Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis IN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis MN, USA
| | - J. Jeffrey Carr
- Department of Radiology, Vanderbilt University, Nashville TN, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
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Jain N, Carmody T, Minhajuddin AT, Toups M, Trivedi MH, Rush AJ, Hedayati SS. Prognostic Utility of a Self-Reported Depression Questionnaire versus Clinician-Based Assessment on Renal Outcomes. Am J Nephrol 2016; 44:234-44. [PMID: 27592294 DOI: 10.1159/000448598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prognostic utility of self-administered depression scales in chronic kidney disease (CKD) independent of a clinician-based major depressive disorder (MDD) diagnosis is neither clearly established nor are the optimal cutoff scores for predicting outcomes. The overlap between symptoms of depression and chronic disease raises the question of whether a cutoff score on a depression scale can be substituted for a time-consuming diagnostic interview to prognosticate risk. METHODS The 16-item Quick Inventory of Depression Symptomatology-Self Report scale (QIDS-SR16) was administered to 266 consecutive outpatients with non-dialysis CKD, followed prospectively for 12 months for an apriori composite outcome of death or dialysis or hospitalization. Association of QIDS-SR16 best cutoff score, determined by receiver/responder operating characteristics curves, with outcomes was investigated using survival analysis. The effect modification of an interview-based clinician MDD diagnosis on this association was ascertained. RESULTS There were 126 composite events. A QIDS-SR16 cutoff ≥8 had the best prognostic accuracy, hazards ratio (HR) = 1.77, 95% CI 1.24-2.53, p = 0.002. This cutoff remained significantly associated with outcomes even after controlling for comorbidities, estimated glomerular filtration rate, hemoglobin and serum albumin, adjusted HR (aHR) = 1.80, 95% CI 1.23-2.62, p = 0.002, and performed similarly to a clinician-based MDD diagnosis (aHR = 1.72, 95% CI 1.14-2.68). Adjustment for MDD conferred the association of QIDS-SR16 with outcomes no longer significant. CONCLUSIONS QIDS-SR16 cutoff ≥8 adds to the prognostic information available to practicing nephrologists during routine clinic visits from comorbidities and laboratory data. This cutoff score performs similar to a clinician diagnosis of MDD and provides a feasible and time-saving alternative to an interview-based MDD diagnosis for determining prognosis in CKD patients.
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Affiliation(s)
- Nishank Jain
- Division of Nephrology, Department of Internal Medicine, University of Arkansas Medical Center, Little Rock, Ark., USA
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Kohlmann S, Gierk B, Murray AM, Scholl A, Lehmann M, Löwe B. Base Rates of Depressive Symptoms in Patients with Coronary Heart Disease: An Individual Symptom Analysis. PLoS One 2016; 11:e0156167. [PMID: 27228158 PMCID: PMC4881911 DOI: 10.1371/journal.pone.0156167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/10/2016] [Indexed: 01/19/2023] Open
Abstract
Background Major depression is common in coronary heart disease (CHD) but challenging to diagnose. Instead of focusing on the overall diagnosis of depression, base rates of depressive symptoms could facilitate screening and management of psychopathology in CHD. The present study investigates the frequency of individual depressive symptoms in CHD and their impact on cardiac and subjective health. Methods In total, 1337 in- and outpatients with CHD were screened for depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9) at three different cardiac treatment sites. Tables stratified by age and gender were designed to illustrate base rates of depressive symptoms. Multiple regression analyses adjusted for sociodemographic and clinical data were conducted to test associations between individual depressive symptoms and quality of life as well impairment caused angina pectoris and dyspnea. Results During the last 14 days, more than half of patients reported a loss of energy (74.9%, 95% Confidence Interval (CI): 70.6–79.2), sleeping problems (69.4%, 95% CI: 64.9–74.0), loss of interest (55.7%, 95% CI: 50.8–60.7). In contrast, psychomotor change (25.6%, 95%CI: 21.3–30.0), feelings of failure (21.9%, 95%CI: 17.7–26.0), suicidal ideations (14.1%, 95%CI: 10.7–17.6) were less frequently reported. Depending on the outcome, only particular depressive symptoms were highly associated with low quality of life and impairment caused by angina pectoris and dyspnea. Loss of energy was the only depressive symptom that reliably predicted all three outcomes. Conclusions Depressive symptoms in CHD are frequent but vary widely in terms of frequency. Findings underline the differential effects of individual depressive symptoms on cardiac health. Presented base rates of depressive symptoms offer clinicians a new way to judge the severity of individual depressive symptoms and to communicate individual PHQ-9 profiles with patients with respect to gender, age, cardiac symptoms and quality of life.
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Affiliation(s)
- Sebastian Kohlmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, and Schön Clinic Hamburg-Eilbek, Hamburg, Germany
- * E-mail:
| | - Benjamin Gierk
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, and Schön Clinic Hamburg-Eilbek, Hamburg, Germany
- Department of Psychiatry, Asklepios Clinic North Ochsenzoll, Hamburg, Germany
| | - Alexandra M. Murray
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, and Schön Clinic Hamburg-Eilbek, Hamburg, Germany
| | - Arne Scholl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, and Schön Clinic Hamburg-Eilbek, Hamburg, Germany
| | - Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, and Schön Clinic Hamburg-Eilbek, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, and Schön Clinic Hamburg-Eilbek, Hamburg, Germany
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Cytokine production capacity in depression and anxiety. Transl Psychiatry 2016; 6:e825. [PMID: 27244234 PMCID: PMC5070051 DOI: 10.1038/tp.2016.92] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 02/26/2016] [Accepted: 03/17/2016] [Indexed: 12/12/2022] Open
Abstract
Recent studies have suggested that immune function may be dysregulated in persons with depressive and anxiety disorders. Few studies examined the expression of cytokines in response to ex vivo stimulation of blood by lipopolysaccharide (LPS) to study the innate production capacity of cytokines in depression and anxiety. To investigate this, baseline data from the Netherlands Study of Depression and Anxiety (NESDA) were used, including persons (18-65 years; 66% women) with current (that is, past month; N=591) or remitted (N=354) DSM-IV depressive or anxiety disorders and healthy controls (N=297). Depressive and anxiety symptoms were measured by means of the Inventory of Depressive Symptomatology (IDS) and the Beck Anxiety Inventory (BAI). Using Multi-Analyte Profiling technology, plasma levels of 13 cytokines were assayed after whole blood stimulation by addition of LPS. Basal plasma levels of C-reactive protein, interleukin-6 and tumor necrosis factor-α were also available. A basal and a LPS summary index were created. Results show that LPS-stimulated inflammation was associated with increased odds of current depressive/anxiety disorders (odds ratio (OR)=1.28, P=0.009), as was the case for basal inflammation (OR=1.28, P=0.001). These associations were no longer significant after adjustment for lifestyle and health (OR=1.13, P=0.21; OR=1.07, P=0.45, respectively). After adjustment for lifestyle and health, interleukin-8 was associated with both remitted (OR=1.25, P=0.02) and current (OR=1.28, P=0.005) disorders. In addition, LPS-stimulated inflammation was associated with more severe depressive (β=0.129, P<0.001) and anxiety (β=0.165, P<0.001) symptoms, as was basal inflammation. Unlike basal inflammation, LPS-stimulated inflammation was still associated with (anxiety) symptom severity after adjustment for lifestyle and health (IDS: interleukin (IL)-8, MCP-1, MMP2; BAI: LPS index, IL-6, IL-8, IL-10, IL-18, MCP-1, MMP2, TNF-β). To conclude, lifestyle and health factors may partly explain higher levels of basal, as well as LPS-stimulated inflammation in persons with depressive and anxiety disorders. However, production capacity of several cytokines was positively associated with severity of depressive and in particular anxiety symptoms, even while taking lifestyle and health factors into account. Elevated IL-8 production capacity in both previously and currently depressed and anxious persons might indicate a genetic vulnerability for these disorders.
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Ozturk C, Balta S, Demir M, Yildirim AO, Unlu M, Arslan Z, Demirkol S, Celik T. The relation between coronary artery ectasia and psychological-environmental factors. J Saudi Heart Assoc 2016; 28:127-8. [PMID: 27053905 PMCID: PMC4803758 DOI: 10.1016/j.jsha.2015.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/23/2015] [Indexed: 10/27/2022] Open
Affiliation(s)
- Cengiz Ozturk
- Department of Cardiology, Gulhane Medical Faculty, Ankara, aTurkey
| | - Sevket Balta
- Department of Cardiology, Gulhane Medical Faculty, Ankara, aTurkey
| | - Mustafa Demir
- Department of Cardiology, Gulhane Medical Faculty, Ankara, aTurkey
| | | | - Murat Unlu
- Department of Cardiology, Gulhane Medical Faculty, Ankara, aTurkey
| | - Zekeriya Arslan
- Department of Cardiology, Ankara Mevki Military Hospital, Ankara, bTurkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Faculty, Ankara, aTurkey
| | - Turgay Celik
- Department of Cardiology, Gulhane Medical Faculty, Ankara, aTurkey
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Abstract
AIMS The aim of this study was to evaluate the relationship of ejection fraction (EF) and depressive symptoms in cardiac surgery patients assigned to nurse-guided cognitive behavioral therapy (CBT) or usual care (UC). METHODS Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Seventy-seven patients (31% women; mean [SD] age, 63.6 [9.8] years) received 8 weeks of either CBT or UC. Using repeated-measures analysis of variance, changes in depressive symptoms over time were evaluated. RESULTS There was a significant interaction among time, treatment group, and EF status (p = 0.019). In the patients with preserved EF (≥40%), mean BDI scores in the UC group worsened by 1.9%, whereas those in the CBT group improved by 31.0%. In the patients with low EF (<40%), mean BDI scores worsened by 26.8% and improved by 75.3% in the UC and CBT groups, respectively. CONCLUSIONS Nurse-guided CBT is effective in reducing depressive symptoms after cardiac surgery, particularly in patients with low EF.
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Acute coronary syndrome-associated depression: the salience of a sickness response analogy? Brain Behav Immun 2015; 49:18-24. [PMID: 25746589 DOI: 10.1016/j.bbi.2015.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/09/2015] [Accepted: 02/23/2015] [Indexed: 12/12/2022] Open
Abstract
Depression emerging in conjunction with acute coronary syndrome (ACS) is thought to constitute a distinct high-risk phenotype with inflammatory determinants. This review critically examines the notion put forward in the literature that ACS-associated depression constitutes a meaningful subtype that is qualitatively different from depressive syndromes observed in psychiatric patients; and evaluates the salience of an analogy to the acute sickness response to infection or injury as an explanatory model. Specific features differentiating ACS-associated depression from other phenotypes are discussed, including differences in depression symptom profiles, timing of the depressive episode in relation to ACS, severity of the cardiac event, and associated immune activation. While an acute sickness response analogy offers a plausible conceptual framework, concrete evidence is lacking for inflammatory activity as the triggering mechanism. It is likely that ACS-associated depression encompasses several causative scenarios.
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Changes in Depressive Symptoms and Mortality in Patients With Heart Failure: Effects of Cognitive-Affective and Somatic Symptoms. Psychosom Med 2015; 77:798-807. [PMID: 26230482 PMCID: PMC4565732 DOI: 10.1097/psy.0000000000000221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Depression is an independent predictor of adverse outcomes in patients with heart failure (HF). However, the effect of changes in cognitive-affective and somatic symptoms on mortality of HF patients is not known. The purpose of this study was to examine whether changes in cognitive-affective and somatic depressive symptoms over time were associated with mortality in HF. METHODS In this secondary analysis of data from the Rural Education to Improve Outcomes in Heart Failure clinical trial, we analyzed data from 457 HF patients (39% female, mean [standard deviation] age = 65.6 [12.8] years) who survived at least 1 year and repeated the Patient Health Questionnaire at 1 year. Cognitive-affective and somatic depression scores were calculated, respectively, based on published Patient Health Questionnaire factor models. Using Cox proportional hazards regression analyses, we evaluated the effect of changes in cognitive-affective and somatic symptoms from baseline to 1 year on cardiac and all-cause deaths. RESULTS Controlling for baseline depression scores and other patient characteristics, the change in somatic symptoms was associated with increased risk of cardiac death during the subsequent 1-year period (hazard ratio = 1.24, 95% confidence interval = 1.07-1.44, p = .005), but the change in cognitive-affective symptoms was not (hazard ratio = 0.94, 95% confidence interval = 0.81-1.08, p = .38). Similar results were found for all-cause mortality. CONCLUSIONS Worsening somatic depressive symptoms, not cognitive-affective symptoms, are independently associated with increased mortality of HF patients. The findings suggest that routine and ongoing assessment of somatic depressive symptoms in HF patients may help clinicians identify patients at increased risk for adverse outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT00415545.
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Dickens C. Depression in People with Coronary Heart Disease: Prognostic Significance and Mechanisms. Curr Cardiol Rep 2015; 17:83. [DOI: 10.1007/s11886-015-0640-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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30
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Currier MB. The Role of Inflammation in Mediating Risk for Medical Disorders in Depressed Patients. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20150501-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Herbison P, Tie CL, Tang E, Bermingham B, Wong CK. Components of depression and 6-year mortality after an acute coronary syndrome. Am J Med 2015; 128:540.e1-6. [PMID: 25534421 DOI: 10.1016/j.amjmed.2014.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Post-myocardial infarct depression includes both somatic depressive symptoms and nonsomatic cognitive symptoms. Their respective relationships to long-term survival are unclear. METHODS Depression was diagnosed by measuring the Beck Depression Inventory-II (BDI-II) on consecutive patients who presented with acute coronary syndrome in 2005. Six-year mortality data were extracted from the National Health Index. This study investigated whether mortality was related to the somatic or cognitive elements of the BDI-II score, controlling for baseline characteristics including the Global Registry of Acute Coronary Events score. The BDI-II, somatic, and cognitive scores were treated as continuous variables. RESULTS Of the 277 patients, 52 died over 6 years. Higher BDI-II score did not predict mortality at 6 years (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.98-1.06). In the Cognitive/Affective-Somatic model, somatic depressive symptoms (OR, 1.10; 95% CI, 1.01-1.20) predicted all-cause mortality, but cognitive/affective depressive symptoms (OR, 1.01; 95% CI, 0.96-1.08) did not. This association attenuated after controlling for age and sex (OR, 1.10; 95% CI, 0.99-1.22), and age, sex, and Global Registry of Acute Coronary Events score (OR, 1.09; 95% CI, 0.99-1.21). Results from the Somatic/Affective-Cognitive model did not reach statistical significance. Differences were small and unlikely to be of clinical importance. CONCLUSIONS In patients with acute coronary syndrome, those who died had a higher baseline BDI-II score, particularly somatic score, although this did not reach statistical significance.
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Affiliation(s)
- Peter Herbison
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Charles LokHui Tie
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - EngWei Tang
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Cheuk-Kit Wong
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Gouweleeuw L, Naudé PJW, Rots M, DeJongste MJL, Eisel ULM, Schoemaker RG. The role of neutrophil gelatinase associated lipocalin (NGAL) as biological constituent linking depression and cardiovascular disease. Brain Behav Immun 2015; 46:23-32. [PMID: 25576802 DOI: 10.1016/j.bbi.2014.12.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/11/2014] [Accepted: 12/23/2014] [Indexed: 12/20/2022] Open
Abstract
Depression is more common in patients with cardiovascular disease than in the general population. Conversely, depression is a risk factor for developing cardiovascular disease. Comorbidity of these two pathologies worsens prognosis. Several mechanisms have been indicated in the link between cardiovascular disease and depression, including inflammation. Systemic inflammation can have long-lasting effects on the central nervous system, which could be associated with depression. NGAL is an inflammatory marker and elevated plasma levels are associated with both cardiovascular disease and depression. While patients with depression show elevated NGAL levels, in patients with comorbid heart failure, NGAL levels are significantly higher and associated with depression scores. Systemic inflammation evokes NGAL expression in the brain. This is considered a proinflammatory effect as it is involved in microglia activation and reactive astrocytosis. Animal studies support a direct link between NGAL and depression/anxiety associated behavior. In this review we focus on the role of NGAL in linking depression and cardiovascular disease.
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Affiliation(s)
- L Gouweleeuw
- Department of Molecular Neurobiology, University of Groningen, Groningen, The Netherlands
| | - P J W Naudé
- Department of Molecular Neurobiology, University of Groningen, Groningen, The Netherlands; Department of Neurology and Alzheimer Research Center, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M Rots
- Department of Molecular Neurobiology, University of Groningen, Groningen, The Netherlands
| | - M J L DeJongste
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - U L M Eisel
- Department of Molecular Neurobiology, University of Groningen, Groningen, The Netherlands
| | - R G Schoemaker
- Department of Molecular Neurobiology, University of Groningen, Groningen, The Netherlands; Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Ozturk S, Yalvac HD, Sivri N, Ozturk HM, Kılıc Y, Bulut E, Celik A, Barlas Y, Tengiz I, Yetkin E. Anxiety and depression scores in patients with coronary artery disease and coronary artery ectasia. Int J Cardiol 2015; 186:299-301. [PMID: 25828141 DOI: 10.1016/j.ijcard.2015.03.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 12/30/2022]
Affiliation(s)
- S Ozturk
- Abant Izzet Baysal University Izzet Baysal Research and Training Hospital, Department of Cardiology, Bolu, Turkey
| | - H D Yalvac
- DR Abdurrahman Yurtaslan Oncology Research and Training Hospital, Department of Psychiatry, Ankara, Turkey
| | - N Sivri
- Trakya University Faculty of Medicine, Department of Cardiology, Edirne Turkey
| | - H M Ozturk
- Abant Izzet Baysal University Izzet Baysal Research and Training Hospital, Department of Psychiatry, Bolu, Turkey
| | - Y Kılıc
- Abant Izzet Baysal University Izzet Baysal Research and Training Hospital, Department of Cardiology, Bolu, Turkey
| | - E Bulut
- Abant Izzet Baysal University Izzet Baysal Research and Training Hospital, Department of Cardiology, Bolu, Turkey
| | - A Celik
- Abant Izzet Baysal University Izzet Baysal Research and Training Hospital, Department of Cardiology, Bolu, Turkey
| | - Y Barlas
- Abant Izzet Baysal University Izzet Baysal Research and Training Hospital, Department of Cardiology, Bolu, Turkey
| | - I Tengiz
- Izmir University Medical Park Hospital, Department of Cardiology, Izmir, Turkey
| | - E Yetkin
- Middle East Hospital, Department of Cardiology, Mersin, Turkey.
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de Miranda Azevedo R, Roest AM, Hoen PW, de Jonge P. Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: a meta-analysis. Psychol Med 2014; 44:2689-2703. [PMID: 24467963 DOI: 10.1017/s0033291714000063] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several prospective longitudinal studies have suggested that somatic/affective depressive symptoms, but not cognitive/affective depressive symptoms, are related to prognosis in patients with heart disease, but findings have been inconsistent. The aim of this study was to investigate the association of cognitive/affective and somatic/affective symptoms of depression with cardiovascular prognosis in patients with heart disease using a meta-analytic perspective. METHOD A systematic search was performed in PubMed, EMBASE and PsycInfo. Thirteen prospective studies on symptom dimensions of depression and cardiovascular prognosis fulfilled the inclusion criteria, providing data on a total of 11,128 subjects. The risk estimates for each dimension of depressive symptoms, demographic and methodological variables were extracted from the included articles. RESULTS In least-adjusted analyses, both the somatic/affective [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.19-1.41, p < 0.001] and cognitive/affective (HR 1.07, 95% CI 1.00-1.15, p = 0.05) dimensions of depressive symptoms were associated with cardiovascular prognosis. In fully adjusted analyses, somatic/affective symptoms were significantly associated with adverse prognosis (HR 1.19, 95% CI 1.10-1.29, p < 0.001) but cognitive/affective symptoms were not (HR 1.04, 95% CI 0.97-1.12, p = 0.25). An increase of one standard deviation (±1 s.d.) in the scores of the somatic/affective dimension was associated with a 32% increased risk of adverse outcomes (HR 1.32, 95% CI 1.17-1.48, p < 0.001). CONCLUSIONS Somatic/affective depressive symptoms were more strongly and consistently associated with mortality and cardiovascular events in patients with heart disease compared with cognitive/affective symptoms. Future research should focus on the mechanisms by which somatic/affective depressive symptoms may affect cardiovascular prognosis.
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Affiliation(s)
- R de Miranda Azevedo
- Department of Psychiatry,University Medical Center Groningen, University of Groningen,The Netherlands
| | - A M Roest
- Department of Psychiatry,University Medical Center Groningen, University of Groningen,The Netherlands
| | - P W Hoen
- Department of Psychiatry,University Medical Center Groningen, University of Groningen,The Netherlands
| | - P de Jonge
- Department of Psychiatry,University Medical Center Groningen, University of Groningen,The Netherlands
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Wiltink J, Michal M, Wild PS, Schneider A, König J, Blettner M, Münzel T, Schulz A, Weber M, Fottner C, Pfeiffer N, Lackner K, Beutel ME. Associations between depression and diabetes in the community: do symptom dimensions matter? Results from the Gutenberg Health Study. PLoS One 2014. [PMID: 25127227 DOI: 10.1371/journal.pone.0105499-] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES While a bidirectional relationship between diabetes and depression has been established, there is little knowledge if the associations are due to somatic-affective or cognitive-affective dimensions of depression. RESEARCH DESIGN AND METHODS In a population-based, representative survey of 15.010 participants we therefore studied the associations of the two dimensions of depression with diabetes and health care utilization among depressed and diabetic participants. Depression was assessed by the Patient Health Questionnaire PHQ-9. RESULTS We found a linear and consistent association between the intensity of depression and the presence of diabetes increasing from 6.9% in no or minimal depression to 7.6% in mild, 9% in moderate and 10.5% in severe depression. There was a strong positive association between somatic-affective symptoms but not with cognitive-affective symptoms and diabetes. Depression and diabetes were both independently related to somatic health care utilisation. CONCLUSIONS Diabetes and depression are associated, and the association is primarily driven by the somatic-affective component of depression. The main limitation of our study pertains to the cross-sectional data acquisition. Further longitudinal work on the relationship of obesity and diabetes should differentiate the somatic and the cognitive symptoms of depression.
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Affiliation(s)
- Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Mainz, Germany
| | - Astrid Schneider
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Schulz
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Weber
- Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Fottner
- Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Wiltink J, Michal M, Wild PS, Schneider A, König J, Blettner M, Münzel T, Schulz A, Weber M, Fottner C, Pfeiffer N, Lackner K, Beutel ME. Associations between depression and diabetes in the community: do symptom dimensions matter? Results from the Gutenberg Health Study. PLoS One 2014; 9:e105499. [PMID: 25127227 PMCID: PMC4134314 DOI: 10.1371/journal.pone.0105499] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/23/2014] [Indexed: 01/12/2023] Open
Abstract
Objectives While a bidirectional relationship between diabetes and depression has been established, there is little knowledge if the associations are due to somatic-affective or cognitive-affective dimensions of depression. Research Design and Methods In a population-based, representative survey of 15.010 participants we therefore studied the associations of the two dimensions of depression with diabetes and health care utilization among depressed and diabetic participants. Depression was assessed by the Patient Health Questionnaire PHQ-9. Results We found a linear and consistent association between the intensity of depression and the presence of diabetes increasing from 6.9% in no or minimal depression to 7.6% in mild, 9% in moderate and 10.5% in severe depression. There was a strong positive association between somatic-affective symptoms but not with cognitive-affective symptoms and diabetes. Depression and diabetes were both independently related to somatic health care utilisation. Conclusions Diabetes and depression are associated, and the association is primarily driven by the somatic-affective component of depression. The main limitation of our study pertains to the cross-sectional data acquisition. Further longitudinal work on the relationship of obesity and diabetes should differentiate the somatic and the cognitive symptoms of depression.
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Affiliation(s)
- Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- * E-mail:
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S. Wild
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Mainz, Germany
| | - Astrid Schneider
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Schulz
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Weber
- Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Fottner
- Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany,
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Austin AW, Gordon JL, Lavoie KL, Arsenault A, Dasgupta K, Bacon SL. Differential association of insulin resistance with cognitive and somatic symptoms of depression. Diabet Med 2014; 31:994-1000. [PMID: 24754892 DOI: 10.1111/dme.12465] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/09/2014] [Accepted: 03/28/2014] [Indexed: 11/29/2022]
Abstract
AIM To examine the associations of depressive symptoms with insulin resistance, evaluating somatic and cognitive depressive symptoms separately. METHODS A total of 328 individuals (mean age 60 years) referred for exercise stress testing, taking part in the Mechanisms and Outcomes of Silent Myocardial Ischemia study, completed the Beck Depression Inventory II. A fasting venous blood sample was collected for assessments of insulin and glucose level; the HOMA-IR (homeostatic model assessment of insulin resistance) was calculated. In principal component analysis, Beck Depression Inventory II items were forced to load onto two components (somatic and cognitive depressive symptoms). Adjusting for age, sex, BMI, medication use, smoking, physical activity, diabetes and cardiovascular disease, general linear model analyses were conducted to examine the associations between the components and log HOMA-IR . RESULTS Principal component analysis showed that nine items loaded onto a cognitive depressive symptoms component and 10 items loaded onto a somatic depressive symptoms component. When examined separately, both components were significantly associated with log HOMA-IR however, when including both components simultaneously in the model, only somatic depressive symptoms remained significantly associated with log HOMA-IR. Back-transformed, a one-unit change in somatic depressive symptoms was associated with a 1.07 (95% CI 1.002, 1.14) change in HOMA-IR and a one-unit change in cognitive depressive symptoms was associated with a 1.03 (95% CI 0.97, 1.14) change in HOMA-IR. CONCLUSION Somatic depressive symptoms seem to be more strongly associated with insulin resistance than do cognitive depressive symptoms. Monitoring somatic depressive symptoms may be more appropriate than monitoring cognitive depressive symptoms among depressed individuals with high insulin resistance.
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Affiliation(s)
- A W Austin
- Montreal Behavioural Medicine Centre, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada; Department of Exercise Science, Concordia University, Montreal, Quebec, Canada; Research Centre, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
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Perez-Moreno AC, Jhund PS, Macdonald MR, Petrie MC, Cleland JG, Böhm M, van Veldhuisen DJ, Gullestad L, Wikstrand J, Kjekshus J, Lewsey JD, McMurray JJ. Fatigue as a Predictor of Outcome in Patients With Heart Failure. JACC-HEART FAILURE 2014; 2:187-97. [DOI: 10.1016/j.jchf.2014.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/02/2014] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
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Beutel ME, Wiltink J, Kirschner Y, Sinning C, Espinola-Klein C, Wild PS, Münzel T, Blettner M, Zwiener I, Lackner K, Michal M. History of depression but not current depression is associated with signs of atherosclerosis: data from the Gutenberg Health Study. Psychol Med 2014; 44:919-925. [PMID: 23822954 DOI: 10.1017/s0033291713001542] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To test the vascular depression hypothesis in the general population, we analyzed the association between current depression, medical history of depression, cognitive and somatic depressive symptom dimensions and measures of atherosclerosis [intima-media thickness (IMT) and carotid plaques]. METHOD We included a representative sample of 5000 participants from the Gutenberg Health Study (GHS). Depression was assessed by the nine-item Patient Health Questionnaire (PHQ-9), and IMT and carotid plaques were measured at both common carotid arteries using an edge detection system. Regression analyses were performed separately for participants with and without cardiovascular disease, adjusting for medical history, cardiovascular risk factors and psychotropic medication. RESULTS Contrary to hypotheses, we found no increased IMT for somatic symptoms of depression; the same was true for depression and cognitive symptoms in the fully adjusted model. Only a moderate relationship between medical history of depression and the presence of atherosclerotic plaques was maintained after correction. CONCLUSIONS The relationship between depression and atherosclerosis may be more complex than previously assumed. Although the vascular depression hypothesis was not supported, our results support the hypothesis that lasting depression leads to arteriosclerosis.
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Affiliation(s)
- M E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - J Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Y Kirschner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - C Sinning
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - C Espinola-Klein
- Department of Medicine II, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - P S Wild
- Department of Medicine II, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - T Münzel
- Department of Medicine II, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - M Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - I Zwiener
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - K Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - M Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Poole L, Leigh E, Kidd T, Ronaldson A, Jahangiri M, Steptoe A. The combined association of depression and socioeconomic status with length of post-operative hospital stay following coronary artery bypass graft surgery: data from a prospective cohort study. J Psychosom Res 2014; 76:34-40. [PMID: 24360139 PMCID: PMC3991423 DOI: 10.1016/j.jpsychores.2013.10.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/24/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To understand the association between pre-operative depression symptoms, including cognitive and somatic symptom subtypes, and length of post-operative stay in patients undergoing coronary artery bypass graft (CABG) surgery, and the role of socioeconomic status (SES). METHODS We measured depression symptoms using the Beck Depression Inventory (BDI) and household income in the month prior to surgery in 310 participants undergoing elective, first-time, CABG. Participants were followed-up post-operatively to assess the length of their hospital stay. RESULTS We showed that greater pre-operative depression symptoms on the BDI were associated with a longer hospital stay (hazard ratio=0.978, 95% CI 0.957-0.999, p=.043) even after controlling for covariates, with the effect being observed for cognitive symptoms of depression but not somatic symptoms. Lower SES augmented the negative effect of depression on length of stay. CONCLUSIONS Depression symptoms interact with socioeconomic position to affect recovery following cardiac surgery and further work is needed in order to understand the pathways of this association.
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Affiliation(s)
- Lydia Poole
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK.
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
| | - Tara Kidd
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, University of London, Blackshaw Road, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK
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Schnabel RB, Michal M, Wilde S, Wiltink J, Wild PS, Sinning CR, Lubos E, Ojeda FM, Zeller T, Munzel T, Blankenberg S, Beutel ME. Depression in atrial fibrillation in the general population. PLoS One 2013; 8:e79109. [PMID: 24324579 PMCID: PMC3850915 DOI: 10.1371/journal.pone.0079109] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/25/2013] [Indexed: 11/19/2022] Open
Abstract
Background Initial evidence suggests that depressive symptoms are more frequent in patients with atrial fibrillation. Data from the general population are limited. Methods and Results In 10,000 individuals (mean age 56±11 years, 49.4% women) of the population-based Gutenberg Health Study we assessed depression by the Patient Health Questionnaire (PHQ-9) and a history of depression in relation to manifest atrial fibrillation (n = 309 cases). The median (25th/75th percentile) PHQ-9 score of depressive symptoms was 4 (2/6) in atrial fibrillation individuals versus 3 (2/6) individuals without atrial fibrillation, . Multivariable regression analyses of the severity of depressive symptoms in relation to atrial fibrillation in cardiovascular risk factor adjusted models revealed a relation of PHQ-9 values and atrial fibrillation (odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01–1.08; P = 0.023). The association was stronger for the somatic symptom dimension of depression (OR 1.08, 95% CI 1.02–1.15; P = 0.0085) than for cognitive symptoms (OR 1.05, 95% CI 0.98–1.11; P = 0.15). Results did not change markedly after additional adjustment for heart failure, partnership status or the inflammatory biomarker C-reactive protein. Both, self-reported physical health status, very good/good versus fair/bad, (OR 0.54, 95% CI 0.41–0.70; P<0.001) and mental health status (OR 0.61 (0.46–0.82); P = 0.0012) were associated with atrial fibrillation in multivariable-adjusted models. Conclusions In a population-based sample we observed a higher burden of depressive symptoms driven by somatic symptom dimensions in individuals with atrial fibrillation. Depression was associated with a worse perception of physical or mental health status. Whether screening and treatment of depressive symptoms modulates disease progression and outcome needs to be shown.
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Affiliation(s)
- Renate B. Schnabel
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
- * E-mail:
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Sandra Wilde
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Philipp S. Wild
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Center of Thrombosis and Hemostasis University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christoph R. Sinning
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Edith Lubos
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Francisco M. Ojeda
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Thomas Munzel
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Leptin and its association with somatic depressive symptoms in patients with the metabolic syndrome. Ann Behav Med 2013; 46:31-9. [PMID: 23436275 DOI: 10.1007/s12160-013-9479-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study aimed to determine the association between circulating leptin levels and total depressive symptoms as well as depressive symptom dimensions (cognitive and somatic) after controlling for important confounding factors. METHODS The study sample was comprised of 135 participants with the metabolic syndrome. Depressive symptoms were measured using the Beck Depression Inventory-II. Leptin was measured using a leptin-specific enzyme immunoassay. Inflammation was assessed using C-reactive protein and interleukin-6 levels. RESULTS Leptin was significantly associated with somatic depressive symptoms (β = 0.33, P = 0.018), but not total depressive symptoms (β = 0.27, P = 0.067) or cognitive depressive symptoms (β = 0.21, P = 0.182), after controlling for age, gender, body mass index, and insulin resistance. Further adjustment for C-reactive protein and interleukin-6 levels did not alter the relationship (β = 0.32, P = 0.023) between circulating leptin levels and somatic depressive symptoms. CONCLUSIONS Leptin is independently associated with somatic depressive symptoms in patients with the metabolic syndrome.
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Abstract
During the past two decades, research in the field of depression and cardiovascular disorders has exploded. Multiple studies have demonstrated that depression is more prevalent in populations with cardiovascular disease, is a robust risk factor for the development of cardiovascular disease in healthy populations, and is predictive of adverse outcomes (such as myocardial infarction and death) among populations with preexisting cardiovascular disease. Mechanistic studies have shown that poor health behaviors, such as physical inactivity, medication nonadherence, and smoking, strongly contribute to this association. Small randomized trials have found that antidepressant therapies may improve cardiac outcomes. Based on this accumulating evidence, the American Heart Association has recommended routine screening for depression in all patients with coronary heart disease. This review examines the key epidemiological literature on depression and cardiovascular disorders and discusses our current understanding of the mechanisms responsible for this association. We also examine current recommendations for screening, diagnosis, and management of depression. We conclude by highlighting new research areas and discussing therapeutic management of depression in patients with cardiovascular disorders.
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Affiliation(s)
- Mary A Whooley
- Department of Medicine, University of California, San Francisco, California 94143, USA.
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Rueda B, Pérez-García A. Coping strategies, depressive symptoms and quality of life in hypertensive patients: Mediational and prospective relations. Psychol Health 2013; 28:1152-70. [DOI: 10.1080/08870446.2013.795223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wiltink J, Michal M, Wild PS, Zwiener I, Blettner M, Münzel T, Schulz A, Kirschner Y, Beutel ME. Associations between depression and different measures of obesity (BMI, WC, WHtR, WHR). BMC Psychiatry 2013; 13:223. [PMID: 24028572 PMCID: PMC3849983 DOI: 10.1186/1471-244x-13-223] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 09/09/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Growing evidence suggests that abdominal obesity is a more important risk factor for the prognosis of cardiovascular and metabolic diseases than BMI. Somatic-affective symptoms of depression have also been linked to cardiovascular risk. The relationship between obesity and depression, however, has remained contradictory. Our aim was therefore to relate body mass index (BMI) and different measures for abdominal obesity (waist circumference, WC, waist-to-hip ratio, WHR, waist-to-height ratio, WHtR) to somatic vs. cognitive-affective symptoms of depression. METHODS In a cross-sectional population based study, data on the first N = 5000 participants enrolled in the Gutenberg Health Study (GHS) are reported. To analyze the relationship between depression and obesity, we computed linear regression models with the anthropometric measure (BMI, WC, WHR, WHtR) as the dependent variable and life style factors, cardiovascular risk factors and psychotropic medications as potential confounders of obesity/depression. RESULTS We found that only the somatic, but not the cognitive-affective symptoms of depression are consistently positively associated with anthropometric measures of obesity. CONCLUSIONS We could demonstrate that the somatic-affective symptoms of depression rather than the cognitive-affective symptoms are strongly related to anthropometric measures. This is also true for younger obese starting at the age of 35 years. Our results are in line with previous studies indicating that visceral adipose tissue plays a key role in the relationship between obesity, depression and cardiovascular disease.
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Affiliation(s)
- Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Isabella Zwiener
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Münzel
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Andreas Schulz
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Yvonne Kirschner
- Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Handberg EM, Eastwood JA, Eteiba W, Johnson BD, Krantz DS, Thompson DV, Vaccarino V, Bittner V, Sopko G, Pepine CJ, Merz NB, Rutledge TR. Clinical implications of the Women's Ischemia Syndrome Evaluation: inter-relationships between symptoms, psychosocial factors and cardiovascular outcomes. WOMEN'S HEALTH (LONDON, ENGLAND) 2013; 9:479-90. [PMID: 24007253 PMCID: PMC4136496 DOI: 10.2217/whe.13.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cardiovascular disease remains the leading cause of death in the USA and is associated with several modifiable (hypertension, diabetes, high cholesterol, tobacco use, physical inactivity, obesity and unhealthy diet) and nonmodifiable (age, gender and family history) risk factors. The role of psychosocial risk factors in the development of cardiovascular disease has a growing body of literature, and differences in men and women have been identified. The Women's Ischemia Syndrome Evaluation provides insight into psychosocial risk factors in a cohort of women presenting with chest pain who had a comprehensive battery of psychosocial assessments and long-term follow-up. This review focuses on symptom presentation for chest pain and its relationship to cardiovascular disease morbidity and mortality, quality of life, healthcare costs and psychosocial predictor variables, including anxiety, depression, hostility and social networks. In the Women's Ischemia Syndrome Evaluation, persistent chest pain was associated with an increased rate of adverse events and relatively high rates of depression and anxiety, with reduced functional capacity and impaired quality of life, over a median of 6 years of follow-up. More research is needed to better understand the relationships between symptoms and negative emotions and to determine whether psychological (pharmacologic and/or cognitive) interventions might impact both psychological and cardiovascular outcomes.
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Affiliation(s)
- Eileen M Handberg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
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Duivis HE, Vogelzangs N, Kupper N, de Jonge P, Penninx BWJH. Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: findings from the Netherlands Study of Depression and Anxiety (NESDA). Psychoneuroendocrinology 2013; 38:1573-85. [PMID: 23399050 DOI: 10.1016/j.psyneuen.2013.01.002] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 12/03/2012] [Accepted: 01/08/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Depression and anxiety have been suggested to be associated with systemic inflammation upregulation. However, results are not always consistent, which may be due to symptom heterogeneity of depression and anxiety. There are some indications that associations with inflammation are mainly driven by somatic symptoms of depression and anxiety. We therefore set out to evaluate the differential association of somatic and cognitive symptoms of depression and anxiety with inflammation, while adjusting for demographic, health related, and lifestyle related variables. METHODS We evaluated baseline data from 2861 participants from the Netherlands Study of Depression and Anxiety (NESDA). The Inventory of Depressive Symptomatology and the Beck Anxiety Inventory were used to assess depressive symptoms and anxiety symptoms. For both scales somatic and cognitive symptoms scales were calculated. Baseline blood samples were collected to determine high sensitivity C-Reactive Protein (CRP), interleukin (IL)-6, and Tumor Necrosis Factor (TNF)-α. We used linear regression to analyze the associations adjusting for demographics and health indicators and markers for an unhealthy lifestyle. RESULTS After adjustment for sociodemographic and health indicators, depressive symptoms were associated with higher levels of CRP, IL-6 and TNF-α. This association was mainly driven by somatic symptoms. For anxiety, somatic symptoms were associated with higher levels of CRP, IL-6 and TNF-α, whereas cognitive anxiety symptoms were associated with CRP (men only). Markers of an unhealthy lifestyle explained the significant associations. CONCLUSIONS Especially somatic symptoms of depression and anxiety are associated with inflammation. However, this association was mostly mediated through unhealthy lifestyles among depressed and anxious individuals.
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Affiliation(s)
- Hester E Duivis
- CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
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Differential associations of depressive symptom dimensions with cardio-vascular disease in the community: results from the Gutenberg health study. PLoS One 2013; 8:e72014. [PMID: 23967272 PMCID: PMC3742482 DOI: 10.1371/journal.pone.0072014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 07/10/2013] [Indexed: 12/30/2022] Open
Abstract
A current model suggested that the somatic symptom dimension accounts for the adverse effect of depression in patients with coronary heart disease (CHD). In order to test this model we sought to determine in a large population-based sample how symptom dimensions of depression are associated with CHD, biomarkers and traditional risk factors. The associations of cognitive and somatic symptom dimensions of depression with CHD, risk factors, endothelial function, and biomarkers of inflammation and myocardial stress were analyzed cross-sectionally in a sample of n = 5000 Mid-Europeans aged 35–74 years from the Gutenberg Health Study (GHS). Only the somatic symptom dimension of depression was associated with CHD, biomarkers (inflammation, vascular function) and cardio-vascular risk factors. When multivariable adjustment was applied by demographic and cardiovascular risk factors, the weak associations of the somatic symptom dimension with the biomarkers disappeared. However, the associations of the somatic symptom dimension with CHD, myocardial infarction, obesity, dyslipidemia and family history of myocardial infarction remained. Both dimensions of depression were independently associated with a previous diagnosis of depression and distressed personality (type D). Thus, our results partly confirm current models: Somatic, but not cognitive-affective symptom dimensions are responsible for the association between depression and CHD, inflammation, vascular function and cardiovascular risk factors in the general population. However, our findings challenge the assumptions that somatic depression might be due to inflammation or vascular dysfunction as consequence of progressed atherosclerotic disease. They rather emphasize a close interplay with life-style factors and with a family history of MI.
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Chilcot J, Rayner L, Lee W, Price A, Goodwin L, Monroe B, Sykes N, Hansford P, Hotopf M. The factor structure of the PHQ-9 in palliative care. J Psychosom Res 2013; 75:60-4. [PMID: 23751240 DOI: 10.1016/j.jpsychores.2012.12.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/18/2012] [Accepted: 12/21/2012] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ-9) is a common screening tool designed to facilitate detection of depression according to DSM-IV criteria. However, the factor structure of the PHQ-9 within the palliative care population has not been evaluated. METHODS 300 participants completed the PHQ-9 within one week of referral to a palliative care service. Participants completed the PHQ-9 again four weeks later (n=213). Confirmatory factor analysis (CFA) and multiple-group CFA were undertaken to test the factor structure of the PHQ-9 and evaluate model invariance over time. RESULTS A two-factor model comprising somatic and cognitive-affective latent factors provided the best fit to the data. Multiple-group CFA suggested model invariance over time. Structural equation modelling revealed that follow-up (time 2) cognitive-affective and somatic symptoms were predicted by their baseline (time 1) factors. CONCLUSIONS The PHQ-9 measures two stable depression factors (cognitive-affective and somatic) within the palliative care population. Studies are now required to examine the trajectories of these symptoms over time in relation to clinical intervention and events.
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Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, UK.
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Steptoe A, Wikman A, Molloy GJ, Messerli-Bürgy N, Kaski JC. Inflammation and symptoms of depression and anxiety in patients with acute coronary heart disease. Brain Behav Immun 2013; 31:183-8. [PMID: 22982340 DOI: 10.1016/j.bbi.2012.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/13/2012] [Accepted: 09/02/2012] [Indexed: 11/28/2022] Open
Abstract
Depression following an acute coronary syndrome (ACS, including myocardial infarction or unstable angina) is associated with recurrent cardiovascular events, but the depressive symptoms that are cardiotoxic appear to have particular characteristics: they are 'incident' rather than being a continuation of prior depression, and they are somatic rather than cognitive in nature. We tested the hypothesis that the magnitude of inflammatory responses during the ACS would predict somatic symptoms of depression 3 weeks and 6 months later, specifically in patients without a history of depressive illness. White cell count and C-reactive protein were measured on the day after admission in 216 ACS patients. ACS was associated with very high levels of inflammation, averaging 13.23×10(9)/l and 17.06 mg/l for white cell count and C-reactive protein respectively. White cell count during ACS predicted somatic symptom intensity on the Beck Depression Inventory 3 weeks later (β=0.122, 95% C.I. 0.015-0.230, p=0.025) independently of age, sex, ethnicity, socioeconomic status, marital status, smoking, cardiac arrest during admission and clinical cardiac risk, but only in patients without a history of depression. At 6 months, white cell count during ACS was associated with elevated anxiety on the Hospital Anxiety and Depression Scale independently of covariates including anxiety measured at 3 weeks (adjusted odds ratio 1.08, 95% C.I. 1.01-1.15, p=0.022). An unpredicted relationship between white cell count during ACS and cognitive symptoms of depression at 6 months was also observed. The study provides some support for the hypothesis that the marked inflammation during ACS contributes to later depression in a subset of patients, but the evidence is not conclusive.
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Affiliation(s)
- Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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