Depression linked to incident CVD, mortality risk across economically diverse settings
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Adults with depressive symptoms appeared to have increased risk for incident CVD and mortality in economically diverse settings, particularly in urban areas, according to study results published in JAMA Psychiatry.
“Studies have shown previously that people with depression are more likely to develop cardiovascular disease and die prematurely, despite being in good health otherwise,” Selina Rajan, MSc, of London School of Hygiene & Tropical Medicine, told Healio Psychiatry. “This has only been shown in high-income countries where the risks were believed to relate, in part, to unhealthy behaviors like smoking and drinking alcohol, and to social factors like deprivation. Although we now know that 75% of people with depression worldwide live in lower- and middle-income countries, it was unclear whether these physical health risks were generalizable to other settings and if so, how much behavioral and social risk factors might contribute to them.”
Rajan and colleagues aimed to identify associations between depressive symptoms and incident CVD and all-cause mortality by countries’ economic development levels and in rural and urban areas. They conducted the multicenter, population-based cohort study between January 2005 and June 2019, with a median follow up of 9.3 years, and included 314 rural and 370 urban communities from 21 economically diverse countries. As exposures, they used four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview, and all-cause mortality, incident CVD and a combined measure of either served as main outcomes and measures. The study included 145,862 participants, of whom 58% were male. Mean participant age was 50.05 years.
Results showed 15,983 (11%) reported four or more depressive symptoms at baseline. Multivariable models revealed associations between depression and incident CVD (HR = 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR = 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR = 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR = 1.23; 95% CI, 1.1-1.37) and noncardiovascular death (HR = 1.21; 95% CI, 1.13-1.31). Risk for the combined outcome increased progressively with number of symptoms, and was highest among individuals with seven symptoms (HR = 1.24; 95% CI, 1.12-1.37) and lowest among those with one symptom (HR = 1.05; 95% CI, 0.92-1.19). Rajan and colleagues observed similar associations between having four or more depressive symptoms and the combined outcome among seven different geographical regions and among countries at all economic levels; however, these associations were stronger in urban (HR = 1.23; 95% CI, 1.13-1.34) than rural (HR = 1.1; 95% CI, 1.02-1.19) communities, as well as among men (HR = 1.27; 95% CI, 1.13-1.38) than women (HR =1.14; 95% CI, 1.06-1.23).
“If we want to reduce the burden of cardiovascular disease and reduce mortality worldwide, we must look at the underlying causes and promote mental well-being," Rajan told Healio Psychiatry. "This is especially important now amidst a pandemic that poses tremendous risks for mental health, and we should keep in mind that most people who suffer from depression actually live in low- and middle-income countries. This is also important because studies like the Global Burden of Disease study, which monitor disease risk factors, don't consider depression to be a risk factor for cardiovascular disease or deaths that are unrelated to suicide or self-harm.”