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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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Dorsolateral prefrontal activation in depressed young adults with and without suicidal ideation during an emotional autobiographical memory task: A fNIRS study. J Affect Disord 2023; 326:216-224. [PMID: 36736791 DOI: 10.1016/j.jad.2023.01.115] [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] [Received: 11/29/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Previous studies have proved that there is a strong association between dorsolateral prefrontal cortex and mood symptoms. This study aimed at using functional near-infrared spectroscopy technology to invest brain activity in dlPFC of depressed individuals with and without suicidal ideation during emotional autobiographical memory test, and to understand their differences in brain cognitive mechanisms. It is helpful to improve our ability to predict and subsequently to prevent suicide. METHODS 85 young adults participated in the study by a simple random sampling method, with health control (34participants), depression with suicidal ideation (17participants), and depression without suicidal ideation (34participants). The average oxyhemoglobin in dlPFC of subjects during EAMT was collected by a 53-channel fNIRS imaging device. RESULTS A marginal significant difference was found between three groups in left dlPFC and right dlPFC. Post hoc analysis revealed that: (1) under negative emotion, depression without suicidal ideation group had higher activation than healthy control group in left dlPFC. (2) under positive emotion, depression with suicidal ideation group had lower activation than healthy control in right dlPFC. CONCLUSIONS Results indicated that the depressed individuals with suicidal ideation had some deficits in executive function in right dlPFC, while the depressed adults without suicidal ideation may have mechanism of resource compensatory recruitment in left dlPFC and the dlPFC abnormality involved in the pathophysiology, may localize within left hemisphere. The depressed individuals with and without suicidal ideation had the different mechanisms in dlPFC and fNIRS can be a neuroimaging biomarker characterizing or predicting suicidality in depressed individuals.
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Psychopathology, Personality and Depression after Acute Coronary Syndrome: A Network Analysis in an Italian Population. Diagnostics (Basel) 2023; 13:diagnostics13050915. [PMID: 36900060 PMCID: PMC10000947 DOI: 10.3390/diagnostics13050915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Several biopsychosocial factors are associated with the onset of a Major Depressive Episode (MDE) after cardiovascular events. However, little is known of the interaction between trait- and state-like symptoms and characteristics and their role in predisposing cardiac patients to MDEs. Three hundred and four subjects were selected among patients admitted for the first time at a Coronary Intensive Care Unit. Assessment comprised personality features, psychiatric symptoms and general psychological distress; the occurrences of MDEs and Major Adverse Cardiovascular Events (MACE) were recorded during a two-year follow-up period. Network analyses of state-like symptoms and trait-like features were compared between patients with and without MDEs and MACE during follow-up. Individuals with and without MDEs differed in sociodemographic characteristics and baseline depressive symptoms. Network comparison revealed significant differences in personality features, not state-like symptoms: the group with MDEs displayed greater Type D personality traits and alexithymia as well as stronger associations between alexithymia and negative affectivity (edge differences between negative affectivity and difficulty identifying feelings was 0.303, and difficulty describing feelings was 0.439). The vulnerability to depression in cardiac patients is associated with personality features but not with state-like symptoms. Personality evaluation at the first cardiac event may help identify individuals more vulnerable to development of an MDE, and they could be referred to specialist care in order to reduce their risk.
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Sanchez GJ, Sumner JA, Schwartz JE, Burg MM, Ye S, Whang W, Peacock J, Duer-Hefele J, Clemow L, Kronish IM, Davidson KW. Anhedonic Depression Is Not Associated With Risk of Recurrent Major Adverse Cardiac Events and All-Cause Mortality in Acute Coronary Syndrome Patients. Ann Behav Med 2023; 57:155-164. [PMID: 34637503 PMCID: PMC9899065 DOI: 10.1093/abm/kaab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Depression after acute coronary syndrome (ACS) is common and increases risks of adverse outcomes, but it remains unclear which depression features are most associated with major adverse cardiac events (MACE) and all-cause mortality (ACM). PURPOSE To examine whether a subtype of depression characterized by anhedonia and major depressive disorder (MDD) predicts 1-year MACE/ACM occurrence in ACS patients compared to no MDD history. We also consider other depression features in the literature as predictors. METHODS Patients (N = 1,087) presenting to a hospital with ACS completed a self-report measure of current depressive symptoms in-hospital and a diagnostic interview assessing MDD within 1 week post-hospitalization. MACE/ACM events were assessed at 1-, 6-, and 12-month follow-ups. Cox regression models were used to examine the association of the anhedonic depression subtype and MDD without anhedonia with time to MACE/ACM, adjusting for sociodemographic and clinical covariates. RESULTS There were 142 MACE/ACM events over the 12-month follow-up. The 1-year MACE/ACM in patients with anhedonic depression, compared to those with no MDD, was somewhat higher in an age-adjusted model (hazard ratio [HR] = 1.63, p = .08), but was not significant after further covariate adjustment (HR = 1.24, p = .47). Of the additional depression features, moderate-to-severe self-reported depressive symptoms significantly predicted the risk of MACE/ACM, even in covariate-adjusted models (HR = 1.72, p = .04), but the continuous measure of self-reported depressive symptoms did not. CONCLUSION The anhedonic depression subtype did not uniquely predict MACE/ACM as hypothesized. Moderate-to-severe levels of total self-reported depressive symptoms, however, may be associated with increased MACE/ACM risk, even after accounting for potential sociodemographic and clinical confounders.
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Affiliation(s)
- Gabriel J Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Matthew M Burg
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - William Whang
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Joan Duer-Hefele
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Lynn Clemow
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Karina W Davidson
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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Kim H, Choi J, Jeong B, Fava M, Mischoulon D, Park MJ, Kim HS, Jeon HJ. Impaired Oxygenation of the Prefrontal Cortex During Verbal Fluency Task in Young Adults With Major Depressive Disorder and Suicidality: A Functional Near-Infrared Spectroscopy Study. Front Psychiatry 2022; 13:915425. [PMID: 35815016 PMCID: PMC9260011 DOI: 10.3389/fpsyt.2022.915425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few previous studies have focused on prefrontal activation in young adults diagnosed with major depressive disorder (MDD) and suicidality via functional near-infrared spectroscopy (fNIRS). MATERIALS AND METHODS A total of 59 healthy controls (HCs), 35 patients with MDD but without suicidality, and 25 patients with MDD and suicidality, between the ages of 18-34 years, were enrolled. Changes in oxygenated hemoglobin (oxy-Hb) levels of the prefrontal cortex at baseline, 4 weeks, and 8 weeks, were evaluated using a protocol consisting of three consecutively repeated trials of rest, speech, and verbal fluency test (VFT) via fNIRS. MDD was diagnosed and suicidality was evaluated based on Mini International Neuropsychiatric Interview (MINI). RESULTS Oxy-Hb levels were impaired in patients with MDD compared with HCs (p = 0.018 for left prefrontal cortex; p = 0.021 for right ventromedial prefrontal cortex; p = 0.002 for left frontopolar cortex). Among the three groups including HCs, MDD without suicidality, and MDD with suicidality, prefrontal oxygenation was most decreased in MDD patients with suicidality. A significantly impaired prefrontal oxygenation in the right ventrolateral prefrontal cortex (VLPFC) was detected after adjusting for covariates in MDD patients with suicidality, compared to those without suicidality. CONCLUSION Impaired prefrontal oxygenation during cognitive execution may serve as a diagnostic biomarker for suicidality in young adult patients with MDD.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea
| | | | - Bumseok Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Mi Jin Park
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Soo Kim
- Department of Psychiatry, Dong-A University Hospital, Busan, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
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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: 2.3] [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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Ortiz A, Bradler K, Moorti P, MacLean S, Husain MI, Sanches M, Goldstein BI, Alda M, Mulsant BH. Reduced heart rate variability is associated with higher illness burden in bipolar disorder. J Psychosom Res 2021; 145:110478. [PMID: 33820643 DOI: 10.1016/j.jpsychores.2021.110478] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/16/2021] [Accepted: 03/27/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with premature death and ischemic heart disease is the main cause of excess mortality. Heart rate variability (HRV) predicts mortality in patients with or without cardiovascular disease. While several studies have analyzed the association between HRV and BD, none has analyzed the association of HRV with illness burden in BD. METHODS 53 participants with BD I and II used a wearable device to assess the association between HRV and factors characterizing illness burden, including illness duration, number and type of previous episode(s), duration of the most severe episode, history of suicide attempts or psychotic symptoms during episodes, and co-morbid psychiatric disorders. We ran unadjusted models and models controlling statistically for age, sex, pharmacotherapy, baseline functional cardiovascular capacity, BMI, years of education, and marital status. We also explored the association between HRV and an overall illness burden index (IBI) integrating all these factors using a weighted geometric mean. RESULTS Adjusted and unadjusted models had similar results. Longer illness duration, higher number of depressive episodes, longer duration of most severe manic/hypomanic episode, co-morbid anxiety disorders, and family history of suicide were associated with reduced HRV, as was bipolar depression severity in the participants experiencing a depressive episode. Finally, a higher IBI score was associated with lower HRV. CONCLUSIONS High illness burden is associated with reduced HRV in BD. While the IBI needs to be validated in a larger sample, it may provide an overall measure that captures illness burden in BD.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | | | - Pooja Moorti
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, ON, Canada
| | - Stephane MacLean
- Institute for Mental Health Research, The Royal Ottawa Hospital, Ottawa, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; National Institute of Mental Health, Klecany, Czech Republic
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
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The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up. Psychosom Med 2020; 81:513-520. [PMID: 31033937 DOI: 10.1097/psy.0000000000000702] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified and whether they were differentially associated with mortality. METHODS Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventory - version 1A [BDI-1A]), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni- and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables. RESULTS Clinically significant depression was a significant predictor of mortality (hazard ratio = 2.088; 95% confidence interval = 1.366-3.192; p = .001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (hazard ratio = 1.982; 95% confidence interval = 1.220-3.217; p = .006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, whereas neither of the two subscales was an independent predictor of mortality in the multivariate analysis. CONCLUSIONS Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.
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Suarez L, Dunlay SM, Schettle SD, Stulak JM, Staab JP. Associations of depressive symptoms with outcomes in patients implanted with left ventricular assist devices. Gen Hosp Psychiatry 2020; 64:93-98. [PMID: 32008725 DOI: 10.1016/j.genhosppsych.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We examined characteristics of depressive symptoms in patients who received left ventricular assist devices (LVAD) to assess their effects on negative outcomes post-implantation. METHODS We retrospectively identified 203 adults with pre-operative PHQ-9 scores who underwent LVAD placement as bridge to transplant (BTT) or destination therapy (DT). We analyzed effects of PHQ-9 total, somatic, and cognitive/affective scores and proportion of patients with clinical depression on all-cause mortality, rehospitalization, major bleeding, and neurologic events post-implantation, controlling for demographics and other medical comorbidities. RESULTS Mean total PHQ-9 scores did not differ between 81 BTT and 122 DT patients (BTT 6.4 vs. DT 7.5, p = 0.12). A higher proportion of DT patients had clinical depression (BTT 22% vs. DT 39%, p = 0.015). Somatic symptoms accounted for three-quarters of total scores in both groups. PHQ-9 domains were not associated with negative outcomes post-implantation. CONCLUSION Depression severity did not differ based on implant strategy, but more DT patients had clinical depression. Somatic symptoms were the biggest contributor to depressive symptoms. Pre-implantation PHQ-9 scores were not associated with outcomes, possibly because depression was mild in both groups. Additional work is needed in LVAD patients to better characterize depressive symptoms and their unique effects on clinical course and well-being.
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Affiliation(s)
- Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America; Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Sarah D Schettle
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
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Depressive Symptoms in Women With Coronary Heart Disease: A Systematic Review of the Longitudinal Literature. J Cardiovasc Nurs 2020; 34:52-59. [PMID: 30138156 DOI: 10.1097/jcn.0000000000000533] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Interpreting studies about women with coronary heart disease and depressive symptoms is challenging: women continue to be underrepresented in research; data are often not presented separately by sex; many studies do not examine depressive symptoms longitudinally, leaving our understanding incomplete; and the use of multiple depressive symptom assessment instruments makes comparisons between studies problematic. PURPOSE The authors of this systematic review examined 20 longitudinal descriptive studies on women with coronary heart disease and depressive symptoms, including prevalence of elevated symptoms, changes in symptoms over time, findings in women versus men, and findings based on assessment instruments. CONCLUSIONS The prevalence of elevated depressive symptoms in women was 35.75% at baseline (hospitalization). The Beck Depression Inventory II yielded the highest baseline prevalence (40.3%), slightly higher than the Depression Interview and Structured Hamilton Scale (36%). The Hospital Anxiety and Depression Scale and the Kellner questionnaire yielded much lower prevalence (21.45% and 23%, respectively). Higher prevalence was linked to inclusion of somatic symptoms on measurement instruments except in post-coronary bypass surgery patients. Symptoms trended toward improvement, particularly in the first 6 months, although a few studies measured beyond this time. Women demonstrated higher prevalence than men initially (35.75% vs 23.46%, respectively) and over 24 months (22.71% vs 19.82%, respectively). CLINICAL IMPLICATIONS Women experienced significantly more depressive symptoms than men initially and over time, although most women's symptoms improved. Measurement varies widely based on instrument and the inclusion/exclusion of somatic symptoms. More longitudinal studies beyond 6 months with prevalence data and analysis by sex/gender are needed.
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Farruggio S, Raina G, Cocomazzi G, Librasi C, Mary D, Gentilli S, Grossini E. Genistein improves viability, proliferation and mitochondrial function of cardiomyoblasts cultured in physiologic and peroxidative conditions. Int J Mol Med 2019; 44:2298-2310. [DOI: 10.3892/ijmm.2019.4365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/02/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Serena Farruggio
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, AGING Project, University of East Piedmont, I‑28100 Novara, Italy
| | - Giulia Raina
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, AGING Project, University of East Piedmont, I‑28100 Novara, Italy
| | - Grazia Cocomazzi
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, AGING Project, University of East Piedmont, I‑28100 Novara, Italy
| | - Carlotta Librasi
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, AGING Project, University of East Piedmont, I‑28100 Novara, Italy
| | - David Mary
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, AGING Project, University of East Piedmont, I‑28100 Novara, Italy
| | - Sergio Gentilli
- General Surgery Unit, Department of Health of Sciences, University of East Piedmont; University Hospital Company Major of Charity, I‑28100 Novara, Italy
| | - Elena Grossini
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, AGING Project, University of East Piedmont, I‑28100 Novara, Italy
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Wium-Andersen MK, Wium-Andersen IK, Jørgensen MB, McGue M, Jørgensen TSH, Christensen K, Osler M. The association between depressive mood and ischemic heart disease: a twin study. Acta Psychiatr Scand 2019; 140:265-274. [PMID: 31306494 PMCID: PMC8039049 DOI: 10.1111/acps.13072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/01/2019] [Accepted: 07/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Individuals with mood disorders have increased risk of cardiovascular disease. The aims of this study were to evaluate if the risk of cardiovascular disease in individuals with mood disorder could be explained by shared genetic and early environmental factors. METHODS We included 6714 Danish middle and old aged twins from two large population-based studies. Cox proportional hazards regression was used to perform individual-level and intra-pair analyses of the association between self-reported depression symptomatology scores and register-based diagnoses of ischemic heart disease. RESULTS Higher depression symptomatology scores (both total, affective, and somatic) were associated with higher incidence of ischemic heart disease after multivariable adjustment in individual-level analyses. In intra-pair analyses, this association was similar but with slightly larger confidence intervals. There was no interaction with gender and no major differences between mono- or dizygotic twins. Within twin pairs, the twin scoring highest on depressive symptoms developed ischemic heart disease more often or earlier than the lower scoring twin. A sensitivity analysis including a 2-year time lag of depression symptomatology to limit the risk of reverse causality showed similar results. CONCLUSION Genetic factors and early life environment do not seem to explain the association between depressive mood and ischemic heart disease.
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Affiliation(s)
- M. K. Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - M. B. Jørgensen
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M. McGue
- The Danish Aging Research Center and The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense, Denmark,Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - T. S. H. Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - K. Christensen
- The Danish Aging Research Center and The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M. Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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13
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Clarifying the Concept of Depression in Women With Coronary Heart Disease. ANS Adv Nurs Sci 2019; 42:E24-E37. [PMID: 30864985 DOI: 10.1097/ans.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The concept of depression in women with coronary heart disease has been poorly defined for several reasons: numerous widely variable instruments that operationalize the concept, divergent proposed instrument cutoff scores, and continued lack of female participants and data analysis by gender in coronary heart disease research. In the forty articles from 1990 to 2018 evaluating depression in women with coronary heart disease, the concept is defined by specific somatic and cognitive symptoms, preceded by particular physiological and psychosocial vulnerabilities, and leads to poorer outcomes. Concept clarification is necessary for accurate diagnosis of depression, leading to more timely and appropriate interventions for women.
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Poole L, Jackowska M. The association between depressive and sleep symptoms for predicting incident disease onset after 6-year follow-up: findings from the English Longitudinal Study of Ageing. Psychol Med 2019; 49:607-616. [PMID: 29807551 PMCID: PMC6378411 DOI: 10.1017/s0033291718001290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The independent effects of depressive symptoms and sleep problems for future physical illness risk have yet to be studied systematically across a variety of disease endpoints. METHODS We analysed data from 7395 participants (65.81 ± 9.39 years; 54.8% female) from the English Longitudinal Study of Ageing (ELSA). Baseline was wave 4 and participants were followed up for 6 years until wave 7. Sleep was measured using an adapted version of the Jenkins Sleep Problems questionnaire and depressive symptoms using the Centre for Epidemiological Studies Depression scale. Participants with the illness of interest at baseline [coronary heart disease (CHD), cancer, diabetes/high blood glucose, arthritis] were excluded from models predicting the onset of that illness at follow-up. Logistic regression was used, entering depressive symptoms and sleep problems simultaneously into models controlling for a wide range of covariates. RESULTS In fully adjusted models depressive symptoms predicted incident CHD (OR 1.11, 95% CI 1.04-1.20, p = 0.004) and diabetes/high blood glucose (OR 1.13, 95% CI 1.04-1.22, p = 0.002) independent of sleep problems; both depressive symptoms (OR 1.10, 95% CI 1.04-1.16, p = 0.002) and sleep problems (OR 1.14, 95% CI 1.02-1.26, p = 0.019) predicted incident arthritis. CONCLUSIONS Sleep problems and depressive symptoms, and a combination of both, were differentially associated with physical illness onset 6 years later. Our findings highlight the importance of taking into account somatic and affective experiences when looking across a variety of different physical illnesses.
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Affiliation(s)
- Lydia Poole
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Marta Jackowska
- Department of Psychology, University of Roehampton, London, SW15 4JD, UK
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15
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Poole L, Steptoe A. Depressive symptoms predict incident chronic disease burden 10 years later: Findings from the English Longitudinal Study of Ageing (ELSA). J Psychosom Res 2018; 113:30-36. [PMID: 30190045 DOI: 10.1016/j.jpsychores.2018.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the association between depressive symptoms and incident chronic illness burden in prospective longitudinal analyses. METHODS We analysed data from 2472 participants (62.88 ± 8.49 years old; 50.8% female) from the English Longitudinal Study of Ageing (ELSA). Depressive symptoms were measured using the Centre for Epidemiological Studies Depression (CES-D) scale at baseline in 2004, and participants were followed up for 10 years. Participants with prevalent illness at baseline (coronary heart disease [CHD], other cardiac illness, stroke, cancer, diabetes/high blood glucose, arthritis, lung disease, osteoporosis and Parkinson's disease) were excluded from models predicting illness burden (the sum of illnesses reported) over follow-up. Linear regression was used controlling for a wide range of covariates. RESULTS The mean chronic illness burden was 0.57, with 43.1% experiencing at least one incident physical illness. Baseline continuous CES-D score was a significant predictor of incident chronic illness burden up to 10 years later (incident rate ratio = 1.05, 95% confidence intervals = 0.05-0.21, p = .003), independent of sociodemographic, behavioural, cognitive and clinical covariates. Sensitivity analyses excluding participants who developed a chronic illness within the 2 years following baseline corroborated the main results. CONCLUSION Depressive symptoms were associated with greater incident chronic illness burden 10 years later. These findings have clinical implications for the treatment of depression in physically healthy older adults.
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Affiliation(s)
- Lydia Poole
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom.
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom
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Machado MO, Veronese N, Sanches M, Stubbs B, Koyanagi A, Thompson T, Tzoulaki I, Solmi M, Vancampfort D, Schuch FB, Maes M, Fava GA, Ioannidis JPA, Carvalho AF. The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses. BMC Med 2018; 16:112. [PMID: 30025524 PMCID: PMC6053830 DOI: 10.1186/s12916-018-1101-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has suggested that depression could be associated with excess all-cause mortality across different settings and populations, although the causality of these associations remains unclear. METHODS We conducted an umbrella review of systematic reviews and meta-analyses of observational studies. PubMed, PsycINFO, and Embase electronic databases were searched through January 20, 2018. Systematic reviews and meta-analyses that investigated associations of depression and all-cause and cause-specific mortality were selected for the review. The evidence was graded as convincing, highly suggestive, suggestive, or weak based on quantitative criteria that included an assessment of heterogeneity, 95% prediction intervals, small-study effects, and excess significance bias. RESULTS A total of 26 references providing 2 systematic reviews and data for 17 meta-analytic estimates met inclusion criteria (19 of them on all-cause mortality); data from 246 unique studies (N = 3,825,380) were synthesized. All 17 associations had P < 0.05 per random effects summary effects, but none of them met criteria for convincing evidence. Associations of depression and all-cause mortality in patients after acute myocardial infarction, in individuals with heart failure, in cancer patients as well as in samples from mixed settings met criteria for highly suggestive evidence. However, none of the associations remained supported by highly suggestive evidence in sensitivity analyses that considered studies employing structured diagnostic interviews. In addition, associations of depression and all-cause mortality in cancer and post-acute myocardial infarction samples were supported only by suggestive evidence when studies that tried to adjust for potential confounders were considered. CONCLUSIONS Even though associations between depression and mortality have nominally significant results in all assessed settings and populations, the evidence becomes weaker when focusing on studies that used structured interviews and those that tried to adjust for potential confounders. A causal effect of depression on all-cause and cause-specific mortality remains unproven, and thus interventions targeting depression are not expected to result in lower mortality rates at least based on current evidence from observational studies.
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Affiliation(s)
- Myrela O Machado
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, 60430-140, Brazil
| | - Nicola Veronese
- Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
- National Research Council, Neuroscience Institute, Aging Branch, 35128, Padova, Italy
| | - Marcos Sanches
- Biostatistical Consulting Unit, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Brendon Stubbs
- Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, AF, SE5 8, UK
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu/CIBERSAM, 08950, Barcelona, Spain
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, SE10 9LS, UK
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, London, UK
- MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, W2 1PG, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Marco Solmi
- Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
- Department of Neuroscience, University of Padova, 35100, Padova, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, 3001, Leuven, Belgium
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, 3070, Leuven, Kortenberg, Belgium
| | - Felipe B Schuch
- Centro Universitário La Salle, Canoas, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- IMPACT Strategic Research Center, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Giovanni A Fava
- Department of Psychology, University of Bologna, viale Berti Pichat 5, 40127, Bologna, Italy
- Department of Psychiatry, Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Palo Alto, CA, 94305, USA
- Department of Health Research and Policy, Stanford University, Palo Alto, CA, 94305, USA
- Department of Statistics, Stanford University, Palo Alto, CA, 94305, USA
- Department of Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, 94305, USA
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction & Mental Health (CAMH), 33 Russel Street, room RS1050S, Toronto, ON, M5S 2S1, Canada.
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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: 1.0] [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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Kupper N, Bonhof C, Westerhuis B, Widdershoven J, Denollet J. Determinants of Dyspnea in Chronic Heart Failure. J Card Fail 2016; 22:201-9. [DOI: 10.1016/j.cardfail.2015.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/25/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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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: 1.2] [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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20
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Wardenaar KJ, Monden R, Conradi HJ, de Jonge P. Symptom-specific course trajectories and their determinants in primary care patients with Major Depressive Disorder: Evidence for two etiologically distinct prototypes. J Affect Disord 2015; 179:38-46. [PMID: 25845748 DOI: 10.1016/j.jad.2015.03.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The course-heterogeneity of Major Depressive Disorder (MDD) hampers development of better prognostic models. Although latent class growth analyses (LCGA) have been used to explain course-heterogeneity, such analyses have failed to also account for symptom-heterogeneity of depressive symptoms. Therefore, the aim was to identify more specific data-driven subgroups based on patterns of course-trajectories on different depressive symptom domains. METHODS In primary care MDD patients (n=205), the presence of the MDD criterion symptoms was determined for each week during a year. Weekly 'mood/cognition' (MC) and 'somatic' (SOM) scores were computed and parallel processes-LCGA (PP-LCGA) was used to identify subgroups based on the course on these domains. The classes׳ associations with baseline predictors and 2-/3-year outcomes were investigated. RESULTS PP-LCGA identified four classes: quick recovery, persisting SOM, persisting MC, and persisting SOM+MC (chronic). Persisting SOM was specifically predicted by higher baseline somatic symptomatology and somatization, and was associated with more somatic depressive symptomatology at long-term follow-up. Persisting MC was specifically predicted by higher depressive severity, thinking insufficiencies, neuroticism, loneliness and lower self-esteem, and was associated with lower mental health related quality of life and more mood/cognitive depressive symptomatology at follow-up. LIMITATIONS The sample was small and contained only primary care MDD patients. The weekly depression assessments were collected retrospectively at 3-month intervals. CONCLUSIONS The results indicate that there are two specific prototypes of depression, characterized by either persisting MC or persisting SOM, which have different sets of associated prognostic factors and long-term outcomes, and could have different etiological mechanisms.
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Affiliation(s)
- K J Wardenaar
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
| | - R Monden
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - H J Conradi
- University of Amsterdam, Department of Clinical Psychology, The Netherlands
| | - P de Jonge
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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Wardenaar KJ, Wanders RBK, Roest AM, Meijer RR, De Jonge P. What does the beck depression inventory measure in myocardial infarction patients? a psychometric approach using item response theory and person-fit. Int J Methods Psychiatr Res 2015; 24:130-42. [PMID: 25994207 PMCID: PMC6878327 DOI: 10.1002/mpr.1467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/04/2015] [Accepted: 03/17/2015] [Indexed: 11/05/2022] Open
Abstract
Observed associations between depression following myocardial infarction (MI) and adverse cardiac outcomes could be overestimated due to patients' tendency to over report somatic depressive symptoms. This study was aimed to investigate this issue with modern psychometrics, using item response theory (IRT) and person-fit statistics to investigate if the Beck Depression Inventory (BDI) measures depression or something else among MI-patients. An IRT-model was fit to BDI-data of 1135 MI patients. Patients' adherence to this IRT-model was investigated with person-fit statistics. Subgroups of "atypical" (low person-fit) and "prototypical" (high person-fit) responders were identified and compared in terms of item-response patterns, psychiatric diagnoses, socio-demographics and somatic factors. In the IRT model, somatic items had lower thresholds compared to depressive mood/cognition items. Empirically identified "atypical" responders (n = 113) had more depressive mood/cognitions, scored lower on somatic items and more often had a Comprehensive International Diagnostic Interview (CIDI) depressive diagnosis than "prototypical" responders (n = 147). Additionally, "atypical" responders were younger and more likely to smoke. In conclusion, the BDI measures somatic symptoms in most MI patients, but measures depression in a subgroup of patients with atypical response patterns. The presented approach to account for interpersonal differences in item responding could help improve the validity of depression assessments in somatic patients.
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Affiliation(s)
- Klaas J Wardenaar
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob B K Wanders
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Annelieke M Roest
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob R Meijer
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Peter De Jonge
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
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Systematic Review and Individual Patient Data Meta-Analysis of Sex Differences in Depression and Prognosis in Persons With Myocardial Infarction: A MINDMAPS Study. Psychosom Med 2015; 77:419-28. [PMID: 25886829 DOI: 10.1097/psy.0000000000000174] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Using combined individual patient data from prospective studies, we explored sex differences in depression and prognosis post-myocardial infarction (MI) and determined whether disease indices could account for found differences. METHODS Individual patient data analysis of 10,175 MI patients who completed diagnostic interviews or depression questionnaires from 16 prospective studies from the MINDMAPS study was conducted. Multilevel logistic and Cox regression models were used to determine sex differences in prevalence of depression and sex-specific effects of depression on subsequent outcomes. RESULTS Combined interview and questionnaire data from observational studies showed that 36% (635/1760) of women and 29% (1575/5526) of men reported elevated levels of depression (age-adjusted odds ratio = 0.68, 95% confidence interval [CI] = 0.60-0.77). The risk for all-cause mortality associated with depression was higher in men (hazard ratio = 1.38, 95% CI = 1.30-1.47) than in women (hazard ratio = 1.22, 95% CI = 1.14-1.31; sex by depression interaction: p < .001). Low left ventricular ejection fraction (LVEF) was associated with higher depression scores in men only (sex by LVEF interaction: B = 0.294, 95% CI = 0.090-0.498), which attenuated the sex difference in the association between depression and prognosis. CONCLUSIONS The prevalence of depression post-MI was higher in women than in men, but the association between depression and cardiac prognosis was worse for men. LVEF was associated with depression in men only and accounted for the increased risk of all-cause mortality in depressed men versus women, suggesting that depression in men post-MI may, in part, reflect cardiovascular disease severity.
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Meurs M, Groenewold NA, Roest AM, van der Wee NJA, Veltman DJ, van Tol MJ, de Jonge P. The associations of depression and hypertension with brain volumes: Independent or interactive? NEUROIMAGE-CLINICAL 2015; 8:79-86. [PMID: 26106530 PMCID: PMC4473298 DOI: 10.1016/j.nicl.2015.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/12/2015] [Accepted: 03/26/2015] [Indexed: 12/29/2022]
Abstract
Independent studies on major depressive disorder (MDD) and hypertension, suggest overlapping abnormalities in brain regions associated with emotional and autonomic processing. However, the unique and interactive effects of MDD and hypertension have never been studied in a single sample. Brain volume in these areas may be an explanatory link in the comorbidity between MDD and hypertension. Voxel-based morphometry was used to test for main effects of MDD (N = 152) and hypertension (N = 82) and their interactions on gray and white matter volumes. Voxel-wise results are reported at p < .05 FWE corrected for the spatial extent of the whole brain and a-priori regions of interest (ROIs: hippocampus, anterior cingulate cortex (ACC) and inferior frontal gyrus (IFG)). In addition, analyses on the extracted total volumes of our ROIs were performed. Interactive effects in the mid-cingulate cortex (MCC) (p FWE = .01), cerebellum (p FWE = .01) and in the ACC total ROI volume (p = .02) were found. MDD in the presence, but not in the absence of hypertension was associated with lower volumes in the ACC and MCC, and with a trend towards larger gray matter volume in the cerebellum. No associations with white matter volumes were observed. Results suggest that the combination of MDD and hypertension has a unique effect on brain volumes in areas implicated in the regulation of emotional and autonomic functions. Brain volume in these regulatory areas may be an explanatory link in the comorbidity between hypertension and MDD.
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Affiliation(s)
- Maaike Meurs
- University of Groningen, University Medical Center, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Hanzeplein 1, Groningen, Groningen 9713 GZ, The Netherlands
| | - Nynke A Groenewold
- University of Groningen, University Medical Center, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Hanzeplein 1, Groningen, Groningen 9713 GZ, The Netherlands
| | - Annelieke M Roest
- University of Groningen, University Medical Center, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Hanzeplein 1, Groningen, Groningen 9713 GZ, The Netherlands
| | - Nic J A van der Wee
- University of Leiden, Leiden University Medical Center, Department of Psychiatry and Leiden Institute for Brain and Cognition, Postbus 9600, Leiden 2300 RC, The Netherlands
| | - Dick J Veltman
- University of Amsterdam, VU University Medical Center, Department of Psychiatry, A.J. Ernststraat 1187, Amsterdam 1081 HL, The Netherlands
| | - Marie-José van Tol
- Neuroimaging Center, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Peter de Jonge
- University of Groningen, University Medical Center, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Hanzeplein 1, Groningen, Groningen 9713 GZ, The Netherlands
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Chronic stress impairs collateral blood flow recovery in aged mice. J Cardiovasc Transl Res 2014; 7:749-55. [PMID: 25315467 DOI: 10.1007/s12265-014-9592-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 01/06/2023]
Abstract
Chronic stress is associated with increased risk of cardiovascular diseases. Aging is also associated with vascular dysfunction. We hypothesize that chronic stress accelerates collateral dysfunction in old mice. Mice were subjected to either chronic social defeat (CSD) or chronic cold stress (CCS). The CSD mice were housed in a box inside an aggressor's cage and exposed to the aggressor. The CCS group was placed in iced water. After chronic stress, mice underwent femoral artery ligation (FAL) and flow recovery was measured. For the CSD group, appearance and use scores of the foot and a behavioral test were performed. CSD impaired collateral flow recovery after FAL. Further, stressed mice had greater ischemic damage, impaired foot function, and altered behavior. The CCS mice also showed impaired collateral flow recovery. Chronic stress causes hind limb collateral dysfunction in old mice, a conclusion reinforced by the fact that two types of stress produced similar changes.
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Marijnissen RM, Wouts L, Schoevers RA, Bremmer MA, Beekman ATF, Comijs HC, Oude Voshaar RC. Depression in context of low neuroticism is a risk factor for stroke: a 9-year cohort study. Neurology 2014; 83:1692-8. [PMID: 25274852 DOI: 10.1212/wnl.0000000000000955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Depression predicts stroke; however, meta-analyses show significant heterogeneity. We hypothesize that the risk of depression on incident stroke is conditional upon the relative contribution of vascular disease and of neuroticism in the underlying pathways to depression in a specific patient. We examined whether depression increases stroke in persons with low neuroticism and without preexisting cardiac disease. METHODS This was a population-based cohort study with 9-year follow-up (n = 2,050; ≥55 years, 52% female). The incidence of stroke was determined by self-report data as well as data from general practitioners and death certificates. Neuroticism was measured using the Dutch Personality Questionnaire and depression using the Center for Epidemiologic Studies-Depression scale. All data were analysed by Cox proportional hazards regression. RESULTS A total of 117 incident cases of stroke occurred during follow-up. Among persons with a history of cardiac disease (n = 401), depression predicted incident stroke independent of neuroticism level with a hazard ratio (HR) of 1.05 (95% confidence interval [CI] 1.01-1.10) (p = 0.02). In persons without cardiac disease (n = 1,649), depression and neuroticism interacted significantly in predicting incident stroke (p = 0.028). Stratified analyses showed that depression predicted incident stroke in those with low neuroticism, HR 1.05 (95% CI 1.00-1.09) (p = 0.033), but not in those with high neuroticism, HR 1.01 (95% CI 0.96-1.05) (p = 0.82). CONCLUSIONS In persons without preexistent cardiac disease, depression is only predictive for future stroke in absence of high neuroticism. This might be explained by the hypothesis that late-life depression in context of low neuroticism is a marker of subclinical vascular disease.
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Affiliation(s)
- Radboud M Marijnissen
- From the Department of Old Age Psychiatry (R.M.M., L.W.), Pro Persona, Wolfheze/Arnhem/Nijmegen; the Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (R.M.M., R.A.S., R.C.O.V.), University Medical Center Groningen, University of Groningen; and the Department of Psychiatry & EMGO Institute for Health and Care Research (M.A.B., A.T.F.B., H.C.C.), VU University Medical Center, Amsterdam, the Netherlands.
| | - Lonneke Wouts
- From the Department of Old Age Psychiatry (R.M.M., L.W.), Pro Persona, Wolfheze/Arnhem/Nijmegen; the Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (R.M.M., R.A.S., R.C.O.V.), University Medical Center Groningen, University of Groningen; and the Department of Psychiatry & EMGO Institute for Health and Care Research (M.A.B., A.T.F.B., H.C.C.), VU University Medical Center, Amsterdam, the Netherlands
| | - Robert A Schoevers
- From the Department of Old Age Psychiatry (R.M.M., L.W.), Pro Persona, Wolfheze/Arnhem/Nijmegen; the Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (R.M.M., R.A.S., R.C.O.V.), University Medical Center Groningen, University of Groningen; and the Department of Psychiatry & EMGO Institute for Health and Care Research (M.A.B., A.T.F.B., H.C.C.), VU University Medical Center, Amsterdam, the Netherlands
| | - Marijke A Bremmer
- From the Department of Old Age Psychiatry (R.M.M., L.W.), Pro Persona, Wolfheze/Arnhem/Nijmegen; the Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (R.M.M., R.A.S., R.C.O.V.), University Medical Center Groningen, University of Groningen; and the Department of Psychiatry & EMGO Institute for Health and Care Research (M.A.B., A.T.F.B., H.C.C.), VU University Medical Center, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- From the Department of Old Age Psychiatry (R.M.M., L.W.), Pro Persona, Wolfheze/Arnhem/Nijmegen; the Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (R.M.M., R.A.S., R.C.O.V.), University Medical Center Groningen, University of Groningen; and the Department of Psychiatry & EMGO Institute for Health and Care Research (M.A.B., A.T.F.B., H.C.C.), VU University Medical Center, Amsterdam, the Netherlands
| | - Hannie C Comijs
- From the Department of Old Age Psychiatry (R.M.M., L.W.), Pro Persona, Wolfheze/Arnhem/Nijmegen; the Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (R.M.M., R.A.S., R.C.O.V.), University Medical Center Groningen, University of Groningen; and the Department of Psychiatry & EMGO Institute for Health and Care Research (M.A.B., A.T.F.B., H.C.C.), VU University Medical Center, Amsterdam, the Netherlands
| | - Richard C Oude Voshaar
- From the Department of Old Age Psychiatry (R.M.M., L.W.), Pro Persona, Wolfheze/Arnhem/Nijmegen; the Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation (R.M.M., R.A.S., R.C.O.V.), University Medical Center Groningen, University of Groningen; and the Department of Psychiatry & EMGO Institute for Health and Care Research (M.A.B., A.T.F.B., H.C.C.), VU University Medical Center, Amsterdam, the Netherlands
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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: 8.4] [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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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: 1.5] [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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Grossini E, Gramaglia C, Farruggio S, Bellofatto K, Anchisi C, Mary D, Vacca G, Zeppegno P. Asenapine increases nitric oxide release and protects porcine coronary artery endothelial cells against peroxidation. Vascul Pharmacol 2014; 60:127-41. [DOI: 10.1016/j.vph.2014.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 11/29/2022]
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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: 2.7] [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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Age-related differences in the effect of psychological distress on mortality: Type D personality in younger versus older patients with cardiac arrhythmias. BIOMED RESEARCH INTERNATIONAL 2013; 2013:246035. [PMID: 24205502 PMCID: PMC3800613 DOI: 10.1155/2013/246035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/19/2013] [Indexed: 12/15/2022]
Abstract
Background. Mixed findings in biobehavioral research on heart disease may partly be attributed to age-related differences in the prognostic value of psychological distress. This study sought to test the hypothesis that Type D (distressed) personality contributes to an increased mortality risk following implantable cardioverter defibrillator (ICD) treatment in younger patients but not in older patients. Methods. The Type D Scale (DS14) was used to assess general psychological distress in 455 younger (≤70 y, m = 59.1) and 134 older (>70 y, m = 74.3) ICD patients. End points were all-cause mortality and cardiac death after a median follow-up of 3.2 years. Results. Older patients had more advanced heart failure and a higher mortality rate (n = 34/25%) than younger patients (n = 60/13%), P = 0.001. Cardiac resynchronization therapy (CRT), but not Type D personality, was associated with increased mortality in older patients. Among younger patients, however, Type D personality was associated with an adjusted hazard ratio = 1.91 (95% CI 1.09–3.34) and 2.26 (95% CI 1.16–4.41) for all-cause and cardiac mortality; other predictors were increasing age, CRT, appropriate shocks, ACE-inhibitors, and smoking. Conclusion. Type D personality was independently associated with all-cause and cardiac mortality in younger ICD patients but not in older patients. Cardiovascular research needs to further explore age-related differences in psychosocial risk.
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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: 78] [Impact Index Per Article: 7.1] [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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Bennik EC, Ormel J, Oldehinkel AJ. Life changes and depressive symptoms: the effects of valence and amount of change. BMC Psychol 2013; 1:14. [PMID: 25566366 PMCID: PMC4270027 DOI: 10.1186/2050-7283-1-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 08/06/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Only few studies have focused on the effects of positive life changes on depression, and the ones that did demonstrated inconsistent findings. The aim of the present study was to obtain a better understanding of the influence of positive life changes on depressive symptoms by decomposing life changes into a valence and an amount of change component. METHODS Using hierarchical multiple regression, we examined the unique effects of valence (pleasantness/unpleasantness) and amount of change on depressive symptoms in 2230 adolescents (M age: 16.28 years) from the TRAILS study. RESULTS Adjusted for age, gender and pre-event depressive symptoms, the amount of life change was positively associated with depressive symptoms. A small excess of positive life changes predicted fewer symptoms, but experiencing a large excess of positive life changes did not have any additional beneficial effects, rather the opposite. Valence was more strongly associated with cognitive-affective than with neurovegetative-somatic symptoms. CONCLUSIONS More positive life changes relative to negative life changes can protect against depressive symptoms, yet only when the amount of change is limited. This study encourages examination of the effects of life changes on specific symptom clusters instead of total numbers of depressive symptoms, which is the current standard.
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Affiliation(s)
- Elise C Bennik
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johan Ormel
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albertine J Oldehinkel
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, 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: 3.3] [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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Roest AM, Carney RM, Freedland KE, Martens EJ, Denollet J, de Jonge P. Changes in cognitive versus somatic symptoms of depression and event-free survival following acute myocardial infarction in the Enhancing Recovery In Coronary Heart Disease (ENRICHD) study. J Affect Disord 2013; 149:335-41. [PMID: 23489396 PMCID: PMC3672326 DOI: 10.1016/j.jad.2013.02.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Randomized controlled trials focusing on the effects of antidepressant treatment in cardiac patients have found modest effects on depressive symptoms but not on cardiac outcomes. A secondary analysis was conducted on data from the Enhancing Recovery in Coronary Heart Disease trial to assess whether changes in somatic or cognitive depressive symptoms following acute MI predicted event-free survival and whether the results differed per treatment arm (cognitive behavior therapy or care as usual). METHODS Patients who met depression criteria and completed the 6th month depression assessment (n=1254) were included in this study. Measurements included demographic and clinical data and the Beck Depression Inventory at baseline and 6 months. The primary endpoint was a composite of recurrent MI and mortality over 2.4 years (standard deviation=0.9 years). RESULTS Positive changes (per 1 point increase) in somatic depressive symptoms (HR: 0.95; 95% CI: 0.92-0.98; p=0.001) but not in cognitive depressive symptoms (HR: 0.98; 95% CI: 0.96-1.01; p=0.19) were related to a reduced risk of recurrent MI and mortality after adjustment for baseline depression scores. There was a trend for an interaction effect between changes in somatic depressive symptoms and the intervention (p=0.08). After controlling for demographic and clinical variables, the association between changes in somatic depressive symptoms and event-free survival remained significant in the intervention arm (HR: 0.93; 95% CI: 0.88-0.98; p=0.01) only. LIMITATIONS Secondary analyses. CONCLUSIONS Changes in somatic depressive symptoms, and not cognitive symptoms, were related to improved outcomes in the intervention arm, independent of demographic and clinical variables.
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Affiliation(s)
- Annelieke M Roest
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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van Dijk S, van den Beukel TO, Kaptein AA, Honig A, le Cessie S, Siegert CE, Boeschoten EW, Krediet RT, Dekker FW. How baseline, new-onset, and persistent depressive symptoms are associated with cardiovascular and non-cardiovascular mortality in incident patients on chronic dialysis. J Psychosom Res 2013; 74:511-7. [PMID: 23731749 DOI: 10.1016/j.jpsychores.2013.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/05/2013] [Accepted: 03/07/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depressive symptoms are associated with mortality among patients on chronic dialysis therapy. It is currently unknown how different courses of depressive symptoms are associated with both cardiovascular and non-cardiovascular mortality. METHODS In a Dutch prospective nation-wide cohort study among incident patients on chronic dialysis, 1077 patients completed the Mental Health Inventory, both at 3 and 12months after starting dialysis. Cox regression models were used to calculate crude and adjusted hazard ratios (HRs) for mortality for patients with depressive symptoms at 3months only (baseline only), at 12months only (new-onset), and both at 3 and 12months (persistent), using patients without depressive symptoms at 3 and 12months as reference group. RESULTS Depressive symptoms at baseline only seemed to be a strong marker for non-cardiovascular mortality (HRadj 1.91, 95% CI 1.26-2.90), whereas cardiovascular mortality was only moderately increased (HRadj 1.41, 95% CI 0.85-2.33). In contrast, new-onset depressive symptoms were moderately associated with both cardiovascular (HRadj 1.66, 95% CI 1.06-2.58) and non-cardiovascular mortality (HRadj 1.46, 95% CI 0.97-2.20). Among patients with persistent depressive symptoms, a poor survival was observed due to both cardiovascular (HRadj 2.14, 95% CI 1.42-3.24) and non-cardiovascular related mortality (HRadj 1.76, 95% CI 1.20-2.59). CONCLUSION This study showed that different courses of depressive symptoms were associated with a poor survival after the start of dialysis. In particular, temporary depressive symptoms at the start of dialysis may be a strong marker for non-cardiovascular mortality, whereas persistent depressive symptoms were associated with both cardiovascular and non-cardiovascular mortality.
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Affiliation(s)
- Sandra van Dijk
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
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Meijer A, Zuidersma M, de Jonge P. Depression as a non-causal variable risk marker in coronary heart disease. BMC Med 2013; 11:130. [PMID: 23676144 PMCID: PMC3661401 DOI: 10.1186/1741-7015-11-130] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/17/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND After decades of investigations, explanations for the prospective association between depression and coronary heart disease (CHD) are still incomplete. DISCUSSION Depression is often suggested to be causally related to CHD. Based on the available literature, we would rather argue that depression can best be regarded as a variable risk marker, that is, a variable that fluctuates together with mechanisms leading to poor cardiovascular fitness. Despite numerous efforts, no evidence is found that manipulation of depression alters cardiovascular outcomes--a key premise for determining causality. To explain the concept of a variable risk marker, we discuss several studies on the heterogeneity of depression suggesting that depression is particularly harmful for the course of cardiovascular disease when it appears to be a physiological consequence of the cardiovascular disease itself. SUMMARY We conclude that instead of depression being a causal risk factor for CHD, the association between depression and CHD is likely confounded, at least by the cardiac disease itself.
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Affiliation(s)
- Anna Meijer
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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Characteristics of psychological interventions that improve depression in people with coronary heart disease: a systematic review and meta-regression. Psychosom Med 2013; 75:211-21. [PMID: 23324874 DOI: 10.1097/psy.0b013e31827ac009] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Despite previous intervention trials, it is unclear which psychological treatments are most effective for people with coronary heart disease (CHD). We have conducted a systematic review with meta-regression to identify the characteristics of psychological interventions that improve depression and depressive symptoms among people with CHD. METHODS Searches of multiple electronic databases up to March 2012 were conducted, supplemented by hand-searching of identified reviews and citation tracing of eligible studies. Studies were included if they reported a randomized controlled trial of a psychological intervention for people with CHD and included depression as an outcome. Data on main effects and characteristics of interventions were extracted from eligible studies. Standardized mean differences (SMDs) were calculated for each study and pooled using random-effects models. Random-effects multivariate meta-regression was performed to identify treatment characteristics associated with improvements in depression. RESULTS Sixty-four independent treatment comparisons were identified. Psychological interventions improved depression, although the effect was small (SMD=0.18, p<.001). Problem solving (SMD=0.34), general education (SMD=0.19), skills training (SMD=0.25), cognitive-behavioral therapy (CBT; SMD=0.23), and relaxation (SMD=0.15) had small effects on CHD patients who were recruited irrespective of their depression status. Among high-quality trials of depressed CHD patients, only CBT showed significant but small effects (SMD=0.31). When entered into multivariable analysis, no individual treatment component significantly improved depression. CONCLUSIONS CBT and problem solving should be considered for inclusion in future treatment developments and randomized controlled trials. However, the effects are small in magnitude, and there is room to develop new interventions that may be more effective.
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Comparing cognitive and somatic symptoms of depression in myocardial infarction patients and depressed patients in primary and mental health care. PLoS One 2013; 8:e53859. [PMID: 23342019 PMCID: PMC3544747 DOI: 10.1371/journal.pone.0053859] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 12/04/2012] [Indexed: 11/19/2022] Open
Abstract
Depression in myocardial infarction patients is often a first episode with a late age of onset. Two studies that compared depressed myocardial infarction patients to psychiatric patients found similar levels of somatic symptoms, and one study reported lower levels of cognitive/affective symptoms in myocardial infarction patients. We hypothesized that myocardial infarction patients with first depression onset at a late age would experience fewer cognitive/affective symptoms than depressed patients without cardiovascular disease. Combined data from two large multicenter depression studies resulted in a sample of 734 depressed individuals (194 myocardial infarction, 214 primary care, and 326 mental health care patients). A structured clinical interview provided information about depression diagnosis. Summed cognitive/affective and somatic symptom levels were compared between groups using analysis of covariance, with and without adjusting for the effects of recurrence and age of onset. Depressed myocardial infarction and primary care patients reported significantly lower cognitive/affective symptom levels than mental health care patients (F (2,682) = 6.043, p = 0.003). Additional analyses showed that the difference between myocardial infarction and mental health care patients disappeared after adjusting for age of onset but not recurrence of depression. These group differences were also supported by data-driven latent class analyses. There were no significant group differences in somatic symptom levels. Depression after myocardial infarction appears to have a different phenomenology than depression observed in mental health care. Future studies should investigate the etiological factors predictive of symptom dimensions in myocardial infarction and late-onset depression patients.
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Abstract
In this editorial, we propose that the association between depression and cardiovascular disease may be conceptualised as a continuous, bidirectional process that originates in youth. The paper byÅberg and colleagues in this issue adds to this literature showing that low cardiovascular fitness at adolescence increases the risk of future depression.
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Differential predictive value of depressive versus anxiety symptoms in the prediction of 8-year mortality after acute coronary syndrome. Psychosom Med 2012; 74:711-6. [PMID: 22923700 DOI: 10.1097/psy.0b013e318268978e] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Both depression and anxiety have been associated with poor prognosis in patients with acute coronary syndrome (ACS). However, certain symptoms and how they are measured may be more important than others. We investigated three different scales to determine their predictive validity. METHODS Patients with ACS (N = 598) completed either the Hospital Anxiety and Depression Scales (HADS-A, HADS-D; n = 316) or the Beck Depression Inventory-Fast Screen (n = 282). Their all-cause mortality status was assessed at 8 years. RESULTS During follow-up, 20% (121/598) of participants died. Cox proportional hazards modeling showed that the HADS-D was predictive of mortality (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.04-1.19), and this association remained significant after adjustment for major clinical/demographic factors, whereas the HADS-A (HR = 0.96, 95% CI = 0.85-1.09) and the Beck Depression Inventory-Fast Screen (HR = 0.99, 95% CI = 0.91-1.08) were not. The following depression items from the HADS-D predicted mortality: "I still enjoy the things I used to enjoy" (HR = 1.38, 95% CI = 1.05-1.82), "I can laugh and see the funny side of things" (HR = 1.48, 95% CI = 1.11-1.96), "I feel as if I am slowed down" (HR = 1.66, 95% CI = 1.24-2.22), and "I look forward with enjoyment to things" (HR = 1.36, 95% CI = 1.08-1.72). CONCLUSIONS Depressive symptoms related to lack of enjoyment or pleasure and physical or cognitive slowing, as measured by the HADS-D, predicted all-cause mortality at 8 years ACS patients, whereas other depressive and anxiety symptoms did not. Whether symptoms of distress predict prognosis in ACS seems to be dependent on the measures and items used.
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Kupper N, Widdershoven JW, Pedersen SS. Cognitive/affective and somatic/affective symptom dimensions of depression are associated with current and future inflammation in heart failure patients. J Affect Disord 2012; 136:567-76. [PMID: 22134045 DOI: 10.1016/j.jad.2011.10.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 10/21/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about whether cognitive/affective depressive symptoms or somatic/affective depressive symptoms are associated with inflammation in heart failure (HF), or that the relation is confounded with disease severity. AIM To examine the association between depressive symptom dimensions in HF patients with inflammatory markers cross-sectionally and prospectively, while adjusting for appropriate confounders. RESULTS Consecutive HF patients completed the Beck Depression Inventory at inclusion and at 12 month follow-up. Cytokines were assessed at both occasions. Cross-sectional--multivariate linear regression analysis (n=110) demonstrated that cognitive/affective depressive symptoms were independently associated with increased levels of sTNFR2 (β=0.20, p<0.05) and IL-1ra (β=0.28, p<0.01). Somatic/affective depressive symptoms were independently related to sTNFR2 (β=0.21, p<0.05). Prospective--(n=125) the level of cognitive/affective depressive symptoms at inclusion was prospectively associated with increased levels of sTNFR1 and sTNFR2 (β=0.21 and 0.25 resp. p<0.05), independent of covariates. Change in somatic/affective depressive symptoms over the 12 month period was associated with sTNFR2 (β=0.30, p=0.008). At symptom level, core depressive cognitions such as hopelessness and guilt drove the relation between the sTNF receptors and the cognitive/affective component, while having sleep problems was the most important associate of the somatic/affective dimension. CONCLUSIONS Baseline cognitive/affective depressive symptoms were prospectively associated with sTNFR1 and sTNFR2 in HF patients, while change in somatic/affective depressive symptoms was associated with sTNFR2, independent from clinical and demographic covariates. Further studies are warranted to replicate these findings and to examine the association between depression dimensions, inflammation and prognosis in HF.
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Affiliation(s)
- Nina Kupper
- Department of Medical Psychology and Neuropsychology, Center of Research on Psychology in Somatic diseases, Tilburg University, and Department of Cardiology, TweeSteden Hospital, Tilburg, The Netherlands.
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De Schutter A, Lavie CJ, Milani RV. Relative importance of comorbid psychological symptoms in patients with depressive symptoms following phase II cardiac rehabilitation. Postgrad Med 2012; 123:72-8. [PMID: 22104456 DOI: 10.3810/pgm.2011.11.2497] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Previous research has demonstrated a high prevalence of psychological risk factors in patients with coronary heart disease (CHD), as well as the benefits of cardiac rehabilitation (CR) on psychological distress (PD) in showing its potential to improve mortality. We examined the impact of CR on mortality by anxiety and/or hostility symptoms in a large population of CHD patients with symptoms of depression following CR. PATIENTS AND METHODS We studied 538 patients with CHD who had completed formal CR. Using a validated questionnaire, symptoms of PD were obtained in 3 domains: anxiety, hostility, and depression. Subjects were divided into 3 groups: nondepressed (n = 502), depression alone (n = 14), and depression with anxiety and/or hostility (n = 22). A multivariate analysis for mortality was performed using a composite PD score (PD = sum of scores for anxiety, depression, and hostility). Subjects were analyzed by total mortality over 3-year follow-up by the National Death Index. RESULTS Mortality was significantly higher in the group with depressive symptoms compared with those without depressive symptoms (19% vs 3%; P < 0.0001). The comorbid depressed group had a slight trend toward higher mortality (22.7% [5 of 22 patients] vs 14% [2 of 14 patients]; P = 0.52). After adjusting for age, body mass index (BMI), ejection fraction, exercise tolerance, and sex using Cox proportional regression, the number of psychiatric comorbidities (ie, depression, anxiety, and hostility), as well as the sum of their raw scores, were significantly associated with increased mortality. However, this effect disappeared after adjusting for depression score (comorbidity hazard ratio, 1.7; 95% confidence interval, 1.0-2.8 vs comorbidity hazard ratio, 1.2; 95% confidence interval, 0.4-3.7 after adjusting). CONCLUSION Psychological distress is an independent predictor of mortality in stable CHD patients following CR; although anxiety and hostility may also modulate this effect, the overall impact seems to be mostly mediated through depression. Patients with persistent depression following CR may need further intervention.
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Affiliation(s)
- Alban De Schutter
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA
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Fiedorowicz JG, Coryell WH, Rice JP, Warren LL, Haynes WG. Vasculopathy related to manic/hypomanic symptom burden and first-generation antipsychotics in a sub-sample from the collaborative depression study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 81:235-43. [PMID: 22584147 PMCID: PMC3567920 DOI: 10.1159/000334779] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/27/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mood disorders substantially increase the risk of cardiovascular disease, though the mechanisms are unclear. We assessed for a dose-dependent relationship between course of illness or treatment with vasculopathy in a well-characterized cohort. METHODS Participants with mood disorders were recruited for the National Institute of Mental Health Collaborative Depression Study (CDS) and followed prospectively. A cross-sectional metabolic and vascular function evaluation was performed on a sub-sample near completion after a mean follow-up of 27 years. RESULTS A total of 35 participants from the University of Iowa (33) and Washington University (2) sites of the CDS consented to a metabolic and vascular function assessment at the Iowa site. In multivariate linear regression, controlling for age, gender, and smoking, manic/hypomanic, but not depressive, symptom burden was associated with lower flow-mediated dilation. Cumulative exposure to antipsychotics and mood stabilizers was associated with elevated augmentation pressure and mean aortic systolic blood pressure. This appeared specifically related to first-generation antipsychotic exposure and mediated by increases in brachial systolic pressure. Although second-generation antipsychotics were associated with dyslipidemia and insulin resistance, they were not associated with vasculopathy. CONCLUSIONS These results provide evidence that chronicity of mood symptoms contribute to vasculopathy in a dose-dependent fashion. Patients with more manic/hypomanic symptoms had poorer endothelial function. First-generation antipsychotic exposure was associated with arterial stiffness, evidenced by higher augmentation pressure, perhaps secondary to elevated blood pressure. Vascular phenotyping methods may provide a promising means of elucidating the mechanisms linking mood disorders to vascular disease.
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Affiliation(s)
- Jess G. Fiedorowicz
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa, 52242,Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, 52242,Corresponding author. Address: 200 Hawkins Drive W278GH, Iowa City, IA 52242 Phone: (319) 384-9267, Fax (319) 353-8656 (J. G. Fiedorowicz)
| | - William H. Coryell
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - John P. Rice
- Mathematics in Psychiatry, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Lois L. Warren
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - William G. Haynes
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa, 52242,Human Cardiovascular Physiology Lab, Institute for Clinical and Translational Science, The University of Iowa, 200 Hawkins Drive, Iowa City, Iowa, 52242
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