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Time-varying depression increases risk for CVD, non-CVD, cancer mortality
Longitudinal study findings revealed that especially in healthy people, time-varying depressive symptoms increase the risk for all-cause and cause-specific mortality — including cardiovascular disease, noncardiovascular disease and cancer death.
“Few if any prior studies have examined the time-varying association between depressive symptoms and excess causes of death, including all-cause and cause-specific mortality,” Nathalie Moise, MD, from the Center for Behavioral Cardiovascular Health, department of medicine, Columbia University Medical Center, and colleagues wrote in BMJ Open. “It is unknown whether depressive symptoms confer an increased risk of excess mortality equally in those with self-reported excellent/very good (in whom depression may be less likely to be recognized) and good/fair/poor health.”
Using data from the REGARDS study, a population-based longitudinal study conducted in the U.S. from 2003 to 2007, researchers examined the relationship between time-varying depressive symptoms and all-cause and cause-specific mortality in a cohort of 29,491 adults aged 45 years and older. They measured elevated depressive symptoms at baseline and on average 5 and 7 years later, and evaluated their association with cancer, non-CVD, CVD and all-cause mortality. Demographic covariates included age, gender, race, education, annual income, insurance status and stroke region.
Of 29,491 participants, 11% had elevated depressive symptoms at baseline and 15.5% died during the follow-up period, which ended in 2012. After fully adjusting for covariates, analysis revealed that time-varying depressive symptoms significantly predicted non-CVD death (adjusted HR = 1.29; 95%CI, 1.16-1.44) and all-cause mortality (aHR =1.24; 95%CI, 1.14-1.39). Although not significant, time-varying depressive symptoms were associated with cancer death (aHR = 1.15; 95%CI, 0.96-1.38) and CVD death (aHR = 1.13; 95%CI, 0.98-1.32). Among participants with excellent or very good health, depressive symptoms increased the risk for mortality by 36% to 54% in fully adjusted models for all-cause (aHR = 1.48; 95%CI, 1.27-1.78), CVD (aHR = 1.37; 95%CI, 0.99-1.91), non-CVD (aHR = 1.54; 95%CI, 1.24-1.92), and cancer (aHR = 1.36; 95% CI, 0.97-1.91) mortality.
“Clinicians should be aware that individuals with elevated depressive symptoms have an increased risk for dying of both specific (eg, cardiovascular disease) and nonspecific causes, including those who self-identify as having ‘excellent’ or ‘very good’ health,” Moise told Healio Psychiatry. “Those with very good/excellent health but elevated depressive symptoms may be less ‘plugged into’ a health care system and/or less likely to have their symptoms recognized and treated. This lends greater urgency to universal screening and improving the implementation of depression treatment models.”– by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.