Role of depressive symptoms in cardiometabolic diseases and subsequent transitions to all-cause mortality: an application of multistate models in a prospective cohort study

Background and purposeThe role of depression in the development and outcome of cardiometabolic diseases remains to be clarified. We aimed to examine the extent to which depressive symptoms affect the transitions from healthy to diabetes, stroke, heart disease and subsequent all-cause mortality in a middle-aged and elderly European population.MethodsA total of 78 212 individuals aged ≥50 years from the Survey of Health Ageing and Retirement in Europe were included. Participants with any baseline cardiometabolic diseases including diabetes, stroke and heart disease were excluded. Depressive symptoms were measured by the Euro-Depression scale at baseline. Participants were followed up to determine the occurrence of cardiometabolic diseases and all-cause mortality. We used multistate models to estimate the transition-specific HRs and 95% CIs after adjustment of confounders.ResultsDuring 500 711 person-years of follow-up, 4742 participants developed diabetes, 2173 had stroke, 5487 developed heart disease and 7182 died. Depressive symptoms were significantly associated with transitions from healthy to diabetes (HR: 1.12, 95% CI: 1.05 to 1.20), stroke (HR: 1.31, 95% CI: 1.18 to 1.44), heart disease (HR: 1.26, 95% CI: 1.18 to 1.34) and all-cause mortality (HR: 1.41, 95% CI: 1.34 to 1.49). After cardiometabolic diseases, depressive symptoms were associated with the increased risk of all-cause mortality in patients with diabetes (HR: 1.54, 95% CI: 1.25 to 1.89), patients who had stroke (HR: 1.29, 95% CI: 1.03 to 1.61) and patients with heart disease (HR: 1.21, 95% CI: 1.02 to 1.44).ConclusionsDepressive symptoms increase the risk of diabetes, stroke and heart disease, and affect the risk of mortality after the onset of these cardiometabolic conditions. Screening and treatment of depressive symptoms may have profound implications for the prevention and prognosis of cardiometabolic diseases.

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Combined influence of depressive symptoms and systemic inflammation on all-cause and cardiovascular mortality: evidence for differential effects by gender in the English Longitudinal Study of Ageing

Psychological Medicine ◽

10.1017/s003329171800209x ◽

2018 ◽

Vol 49 (09) ◽

pp. 1521-1531 ◽

Cited By ~ 2

Author(s):

Samantha Lawes ◽

Panayotes Demakakos ◽

Andrew Steptoe ◽

Glyn Lewis ◽

Livia A. Carvalho

Keyword(s):

Depressive Symptoms ◽

Longitudinal Study ◽

Mortality Risk ◽

Depression Scale ◽

Health Behaviours ◽

Men And Women ◽

Increased Risk ◽

All Cause Mortality ◽

English Longitudinal Study ◽

Cvd Mortality

AbstractBackgroundDepressive symptoms and inflammation are risk factors for cardiovascular disease (CVD) and mortality. We investigated the combined association of these factors with the prediction of CVD and all-cause mortality in a representative cohort of older men and women.MethodsWe measured C-reactive protein (CRP) and depressive symptoms in 5328 men and women aged 52–89 years in the English Longitudinal Study of Ageing. Depressive symptoms were measured using the eight-item Centre for Epidemiological Studies Depression Scale. CRP was analysed from peripheral blood. Mortality was ascertained from national registers and associations with depressive symptoms and inflammation were estimated using Cox proportional hazard models.ResultsWe identified 112 CVD related deaths out of 420 all-cause deaths in men and 109 CVD related deaths out of 334 all-cause deaths in women over a mean follow-up of 7.7 years. Men with both depressive symptoms and high CRP (3–20 mg/L) had an increased risk of CVD mortality (hazard ratio; 95% confidence interval: 3.89; 2.04–7.44) and all-cause mortality (2.40; 1.65–3.48) after adjusting for age, socioeconomic variables and health behaviours. This considerably exceeds the risks associated with high CRP alone (CVD 2.43; 1.59–3.71, all-cause 1.49; 1.20–1.84). There was no significant increase in mortality risk associated with depressive symptoms alone in men. In women, neither depressive symptoms or inflammation alone or the combination of both significantly predicted CVD or all-cause mortality.ConclusionsThe combination of depressive symptoms and increased inflammation confers a considerable increase in CVD mortality risk for men. These effects appear to be independent, suggesting an additive role.

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The combination of depressive symptoms and smoking shorten life expectancy among the aged

International Psychogeriatrics ◽

10.1017/s1041610211002201 ◽

2011 ◽

Vol 24 (4) ◽

pp. 624-630 ◽

Cited By ~ 4

Author(s):

Cristina Fortes ◽

Simona Mastroeni ◽

Sperati Alessandra ◽

Juliana Lindau ◽

Sara Farchi ◽

...

Keyword(s):

Depressive Symptoms ◽

Life Expectancy ◽

Elderly People ◽

Proportional Hazards ◽

Depression Scale ◽

Cox Proportional Hazards ◽

Secondary Outcome ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

ABSTRACTBackground: Depression is a potential risk factor for mortality among the aged and it is also associated with other chronic diseases and unhealthy lifestyles that may also affect mortality. The purpose of this study was to investigate the association between depressive symptoms and mortality, controlling for health, nutritional status, and life-style factors.Methods: A cohort of elderly people (N = 167) was followed-up for ten years. Information on socio-demographic characteristics, medical history, smoking, and alcohol consumption was collected. The primary outcome was all-cause mortality; the secondary outcome was cancer-specific mortality. The Geriatric Depression Scale (GDS-15) was used to assess depression. Using a multivariable Cox proportional hazards regression, we examined the association between depressive symptoms and mortality.Results: Elderly people with depression (scoring above the depression cut-off of 7) had a 53% increased risk of mortality (relative risk (RR) 1.53; 95%CI: 1.05–2.24) compared to non-depressed subjects. The combination of depressive symptoms with smoking was associated with a particularly higher risk of mortality (RR: 2.61; 95%CI: 1.28–5.31), after controlling for potential confounders.Conclusions: Depressive symptoms are associated with a significantly increased risk of all-cause mortality. The combination of depressive symptoms and smoking shorten life expectancy among the aged.

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Incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-021-01313-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Amy Groenewegen ◽

Victor W. Zwartkruis ◽

Betül Cekic ◽

Rudolf. A. de Boer ◽

Michiel Rienstra ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Incidence Rate ◽

Diabetes Status ◽

Increased Risk ◽

Patients With Diabetes ◽

Rate Ratios ◽

Age And Sex

Abstract Background Diabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed. Methods A dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated. Results Mean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter. Conclusion There is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk.

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Language Proficiency and Migrant–Native Disparities in Postpartum Depressive Symptoms

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094782 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4782

Author(s):

Sousan Hamwi ◽

Elsa Lorthe ◽

Henrique Barros

Keyword(s):

Depressive Symptoms ◽

Language Proficiency ◽

Help Seeking ◽

Depression Scale ◽

Migrant Women ◽

Prevention Measures ◽

Native Women ◽

Logistic Regression Models ◽

Postpartum Depressive Symptoms

Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.

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Association of FKBP5 genotype with depressive symptoms in patients with coronary heart disease: a prospective study

Journal of Neural Transmission ◽

10.1007/s00702-020-02243-6 ◽

2020 ◽

Vol 127 (12) ◽

pp. 1651-1662

Author(s):

Julia Brandt ◽

Katharina Warnke ◽

Silke Jörgens ◽

Volker Arolt ◽

Katja Beer ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Depressive Symptoms ◽

Coronary Revascularization ◽

Central Element ◽

Depression Scale ◽

Stress System ◽

Linear Regression Models ◽

A Prospective Study

AbstractDepression and coronary heart disease (CHD) are prevalent and often co-occurring disorders. Both have been associated with a dysregulated stress system. As a central element of the stress system, the FKBP5 gene has been shown to be associated with depression. In a prospective design, this study aims to investigate the association of FKBP5 with depressive symptoms in CHD patients. N = 268 hospitalized CHD patients were included. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS-D) at four time points (baseline, and after 1 month, 6 months, and 12 months). The functional FKBP5 single-nucleotide polymorphism (SNP) rs1360780 was selected for genotyping. Linear regression models showed that a higher number of FKBP5 C alleles was associated with more depressive symptoms in CHD patients both at baseline (p = 0.015) and at 12-months follow-up (p = 0.025) after adjustment for confounders. Further analyses revealed that this effect was driven by an interaction of FKBP5 genotype with patients’ prior CHD course. Specifically, only in patients with a prior myocardial infarction or coronary revascularization, more depressive symptoms were associated with a higher number of C alleles (baseline: p = 0.046; 1-month: p = 0.026; 6-months: p = 0.028). Moreover, a higher number of C alleles was significantly related to a greater risk for dyslipidemia (p = .016). Our results point to a relevance of FKBP5 in the association of the two stress-related diseases depression and CHD.

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Increased Remnant Cholesterol Explains Part of Residual Risk of All-Cause Mortality in 5414 Patients with Ischemic Heart Disease

Clinical Chemistry ◽

10.1373/clinchem.2015.253757 ◽

2016 ◽

Vol 62 (4) ◽

pp. 593-604 ◽

Cited By ~ 52

Author(s):

Anne-Marie K Jepsen ◽

Anne Langsted ◽

Anette Varbo ◽

Lia E Bang ◽

Pia R Kamstrup ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Ldl Cholesterol ◽

Hdl Cholesterol ◽

Hazard Ratio ◽

Residual Risk ◽

Ischemic Heart ◽

Increased Risk ◽

All Cause Mortality ◽

Remnant Cholesterol

Abstract BACKGROUND Increased concentrations of remnant cholesterol are causally associated with increased risk of ischemic heart disease. We tested the hypothesis that increased remnant cholesterol is a risk factor for all-cause mortality in patients with ischemic heart disease. METHODS We included 5414 Danish patients diagnosed with ischemic heart disease. Patients on statins were not excluded. Calculated remnant cholesterol was nonfasting total cholesterol minus LDL and HDL cholesterol. During 35836 person-years of follow-up, 1319 patients died. RESULTS We examined both calculated and directly measured remnant cholesterol; importantly, however, measured remnant cholesterol made up only 9% of calculated remnant cholesterol at nonfasting triglyceride concentrations <1 mmol/L (89 mg/dL) and only 43% at triglycerides >5 mmol/L (443 mg/dL). Multivariable-adjusted hazard ratios for all-cause mortality compared with patients with calculated remnant cholesterol concentrations in the 0 to 60th percentiles were 1.2 (95% CI, 1.1–1.4) for patients in the 61st to 80th percentiles, 1.3 (1.1–1.5) for the 81st to 90th percentiles, 1.5 (1.1–1.8) for the 91st to 95th percentiles, and 1.6 (1.2–2.0) for patients in the 96th to 100th percentiles (trend, P < 0.001). Corresponding values for measured remnant cholesterol were 1.0 (0.8–1.1), 1.2 (1.0–1.4), 1.1 (0.9–1.5), and 1.3 (1.1–1.7) (trend, P = 0.006), and for measured LDL cholesterol 1.0 (0.9–1.1), 1.0 (0.8–1.2), 1.0 (0.8–1.3), and 1.1 (0.8–1.4) (trend, P = 0.88). Cumulative survival was reduced in patients with calculated remnant cholesterol ≥1 mmol/L (39 mg/dL) vs <1 mmol/L [log-rank, P = 9 × 10−6; hazard ratio 1.3 (1.2–1.5)], but not in patients with measured LDL cholesterol ≥3 mmol/L (116 mg/dL) vs <3 mmol/L [P = 0.76; hazard ratio 1.0 (0.9–1.1)]. CONCLUSIONS Increased concentrations of both calculated and measured remnant cholesterol were associated with increased all-cause mortality in patients with ischemic heart disease, which was not the case for increased concentrations of measured LDL cholesterol. This suggests that increased concentrations of remnant cholesterol explain part of the residual risk of all-cause mortality in patients with ischemic heart disease.

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The influence of workplace stress and coping on depressive symptoms among registered nurses in Bangladesh

Belitung Nursing Journal ◽

10.33546/bnj.1959 ◽

2022 ◽

Author(s):

Reva Mondal ◽

Yajai Sitthimongkol ◽

Nopporn Vongsirimas ◽

Natkamol Chansatitporn ◽

Kathy Hegadoren

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Coping Strategies ◽

Registered Nurses ◽

Depression Scale ◽

Workplace Stress ◽

Unique Contribution ◽

Workplace Stressors ◽

Increased Risk ◽

The Relationship

Background: Nurses report high levels of workplace stress, which has been linked to an increased risk for experiencing depressive symptoms.Nurses’ workplace stress is also linked to increased absenteeism and decreased job satisfaction. Objectives: The objectives of this study were to examine: (1) the incidence of depressive symptoms among hospital-based registered nurses in Bangladesh; (2) common sources of workplace stress and their relationships to individual characteristics and depressive symptom scores; and (3) the potential mediating roles of coping strategies in the relationship between workplace stress and depressive symptoms. Methods: A cross-sectional study design involved three hundred and fifty-two registered nurses. Data were collected using a demographic questionnaire and three standardized tools measuring sources of nurses’ workplace stress, coping strategies, and depressive symptoms. Results: More than half of the participants scored ≥ 16 on the CES-D, which was associated with a major depression episode. Total NSS scores had a small but significant influence on scores on the depression scale. Coping strategies had no mediated effect on the relationship between workplace stress and scores on the depression scale. Low-reliability coefficients for subscales of two of the standardized tools highlight the challenge for researchers in developing countries to address contextual differences that may influence the meanings attached to individual items. Conclusion: Findings suggest that the mental health of registered nurses in Bangladesh requires immediate attention in part by attending to workplace stressors. Further research should focus on a deeper understanding of Bangladeshi registered nurses’ work experiences and the unique contribution that workplace stressors have on their physical and mental health.

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The influence of subjective sleep quality on the association between eveningness and depressive symptoms.

10.31234/osf.io/qkrsg ◽

2018 ◽

Author(s):

Charlotte Mary Horne ◽

Ray Norbury

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Mediation Analysis ◽

Depression Scale ◽

Well Being ◽

Poor Sleep ◽

Subjective Sleep Quality ◽

Subjective Sleep ◽

Increased Risk ◽

Healthy Participants

Increasing evidence suggests that eveningness is associated with increased risk for depression. Eveningness, however, is also associated with poor sleep quality and the unique role of eveningness in depressive symptomatology remains to be elucidated. The goal of the current study, therefore, was to examine the inter-relationships between eveningness, subjective sleep quality and depressive symptoms in healthy participants free of current or previous depression and sleep disorder. Here, 167 healthy participants (mean age 24.16, 129/38 females/males) completed the reduced Morningness-Eveningness Questionnaire (rMEQ), the Pittsburgh Sleep Quality Index (PSQI) and the Centre for Epidemiological Studies Depression Scale (CES-D). Bootstrap mediation analysis for a simple mediation model including rMEQ, PSQI and CES-D was applied. Eveningness was associated with increased depressive symptoms and mediation analysis showed that this relationship was partly mediated by sleep quality. Our results suggest that indicators of depression observed in evening-type individuals cannot be attributed exclusively to disturbed sleep. We suggest that interventions that target both sleep quality and dysfunctionl cognitive styles would be optimal to promote well-being in evening-type individuals.

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Role of Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: An updated meta-analysis of randomized controlled trials.

10.22541/au.162247344.43377091/v1 ◽

2021 ◽

Author(s):

Hua Ma ◽

QIng Gu ◽

Huining Niu ◽

Xiaohua Li ◽

Rong Wang

Keyword(s):

Cardiovascular Disease ◽

Primary Prevention ◽

Meta Analysis ◽

Significant Risk ◽

Diabetic Patients ◽

Primary Endpoints ◽

All Cause Mortality ◽

Patients With Diabetes ◽

Rule Out

Background: The use of Aspirin in the primary prevention of cardiovascular disease (CVD) is still a topic of debate, especially in patients with diabetes. The present meta-analysis aims to rule out the efficacy of Aspirin in patients with diabetes and to compare the effectiveness of Aspirin with a placebo (or no treatment) for the primary prevention of CVD and all-cause mortality events in people with diabetes. Materials and Methods: An extensive and systematic search was conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using Aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received Aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The risk of bias (RoB) in included studies was evaluated using the QUADAS-2 tool. Results: A total of 5 studies out of 13 were included with 23,570 diabetic patients; 11,738 allocated to Aspirin and 11,832 allocated to the placebo group. In patients with diabetes, there was no difference between Aspirin and placebo with respect to the risk of all-cause death with a confidence interval (CI) varying 0.63 to 1.17. In addition, there were no differences in the bleeding outcomes with an odds ratio of 1.4411 (CI 0.47 to 4.34). Conclusion: Aspirin has no significant risk on primary endpoints of cardiovascular events and the bleeding outcomes in diabetic patients compared to placebo. More research on the use of Aspirin alone or in combination with other antiplatelet drugs is required in patients with diabetes to supplement currently available research.

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Depression and Dementia: The Role of Cortisol and Vascular Brain Lesions. AGES-Reykjavik Study

Journal of Alzheimer s Disease ◽

10.3233/jad-215241 ◽

2021 ◽

pp. 1-11

Author(s):

Lotte Gerritsen ◽

Emma L. Twait ◽

Palmi V. Jonsson ◽

Vilmundur Gudnason ◽

Lenore J. Launer ◽

...

Keyword(s):

Brain Mri ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Diagnostic Interview ◽

Late Life Depression ◽

Cox Proportional Hazard ◽

Dementia Risk ◽

Increased Risk ◽

Cox Proportional Hazard Models

Background: Late-life depression (LLD) is related to an increased risk of developing dementia; however, the biological mechanisms explaining this relationship remain unclear. Objective: To determine whether the relationship between LLD and dementia can be best explained by the glucocorticoid cascade or vascular hypothesis. Methods: Data are from 4,354 persons (mean age 76±5 years) without dementia at baseline from the AGES-Reykjavik Study. LLD was assessed with the MINI diagnostic interview (current and remitted major depressive disorder [MDD]) and the Geriatric Depression Scale-15. Morning and evening salivary cortisol were collected (glucocorticoid cascade hypothesis). White matter hyperintensities (WMH; vascular hypothesis) volume was assessed using 1.5T brain MRI. Using Cox proportional hazard models, we estimated the associations of LLD, cortisol levels, and WMH volume with incident all-cause dementia, AD, and non-AD dementia. Results: During 8.8±3.2 years of follow-up, 843 persons developed dementia, including 397 with AD. Current MDD was associated with an increased risk of developing all-cause dementia (HR = 2.17; 95% CI 1.66–2.67), with risks similar for AD and non-AD, while remitted MDD was not (HR = 1.02; 95% CI 0.55–1.49). Depressive symptoms were also associated with increased risk of dementia, in particular non-AD dementias. Higher levels of evening cortisol increased risk of dementia, but this was independent of MDD. WMH partially explained the relation between current MDD and dementia risk but remained increased (HR = 1.71; 95% CI 1.34–2.08). Conclusion: The current study highlights the importance of LLD in developing dementia. However, neither the glucocorticoid cascade nor the vascular hypotheses fully explained the relation between depression and dementia.

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