Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study (original) (raw)
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Neurology: Clinical Practice, 2020
ObjectiveThe purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants.MethodsThe study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003–2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4]: 0, 1–3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors.ResultsThere were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1–3 had 39% increased stroke risk (hazar...
PLoS ONE, 2012
Background: Depressive symptoms are associated with increased incident and recurrent cardiovascular events. In 2010, the American Heart Association published the Life's Simple 7, a metric for assessing cardiovascular health as measured by 4 health behaviors (smoking, physical activity, body mass index, diet) and 3 biological measures (cholesterol, blood pressure, glucose). The association between depressive symptoms and the Life's Simple 7 has not yet been explored. Methods: Data from 20,093 participants $45 years of age who enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007 and who had complete data available on Life's Simple 7 components were used for these analyses. The prevalence of ideal, intermediate, and poor health on each Life's Simple 7 component and total Life's Simple 7 scores were compared between participants with and without depressive symptoms. Depressive symptoms were measured using the 4-item Centers for Epidemiologic Studies of Depression scale. Results: Participants with depressive symptoms were more likely to have poor levels on each of the Life's Simple 7 components other than cholesterol [adjusted prevalence ratios (95% CI): smoking 1.41 (1.29-1.55); physical activity 1.38 (1.31-1.46); body mass index 1.09 (1.04-1.15); diet 1.08 (1.06-1.10); blood pressure 1.11 (1.02-1.21); glucose 1.24 (1.09-1.41)]. There was a graded association between increasing depressive symptoms and lower total Life's Simple 7 score. Conclusion: Depressive symptoms are associated with worse cardiovascular health on the overall Life's Simple 7 and on individual components representing both health behaviors and biological factors.
Changes in Depressive Symptoms and Subsequent Risk of Stroke in the Cardiovascular Health Study
Stroke, 2017
Depression is associated with stroke, but the effects of changes in depressive symptoms on stroke risk are not well understood. This study examined whether depressive symptom changes across 2 successive annual assessments were associated with incident stroke the following year. We used visit data from 4319 participants of the Cardiovascular Health Study who were stroke free at baseline to examine whether changes in depressive symptoms classified across 2 consecutive annual assessments predicted incident first stroke during the subsequent year. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression scale (high versus low at ≥10). Survival models were inverse probability weighted to adjust for demographics, health behaviors, medical conditions, past depressive symptoms, censoring, and survival. During follow-up, 334 strokes occurred. Relative to stable low scores of depressive symptoms, improved depression symptoms were associated with almost n...
Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults
Journal of the American Heart Association, 2015
Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit. Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was ≥3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (≥65 years), race or ethnicity (non-Hispan...
Depressive Symptoms and Cardiovascular Mortality in Older Black and White Adults
Circulation-cardiovascular Quality and Outcomes, 2011
Background-An emerging body of research suggests that depressive symptoms may confer an "accelerated risk" for cardiovascular disease (CVD) in blacks compared with whites. Research in this area has been limited to cardiovascular risk factors and early markers; less is known about black-white differences in associations with important clinical end points. Methods and Results-The authors examined the association between depressive symptoms and overall CVD mortality, ischemic heart disease (IHD) mortality, and stroke mortality in a sample of 6158 (62% black; 61% female) community-dwelling older adults. Cox proportional hazards models were used to model time-to-CVD, IHD, and stroke death over a 9-to 12-year follow-up. In race-stratified models adjusted for age and sex, elevated depressive symptoms were associated with CVD mortality in blacks (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.61 to 2.36; PϽ0.001) but were not significantly associated with CVD mortality in whites (HR, 1.26; 95% CI, 0.95 to 1.68; Pϭ0.11; race by depressive symptoms interaction, Pϭ0.03). Similar findings were observed for IHD mortality (black: HR, 1.99; 95% CI, 1.49 to 2.64; PϽ0.001; white: HR, 1.28; 95% CI, 0.86 to 1.89; Pϭ0.23) and stroke mortality (black: HR, 2.08; 95% CI, 1.32 to 3.27; Pϭ0.002; white: HR, 1.32; 95% CI, 0.69 to 2.52; Pϭ0.40). Findings for total CVD mortality and IHD mortality were attenuated but remained significant after adjusting for standard risk factors. Findings for stroke were reduced to marginal significance. Conclusions-Elevated depressive symptoms were associated with multiple indicators of CVD mortality in older blacks but not in whites. Findings were not completely explained by standard risk factors. Efforts aimed at reducing depressive symptoms in blacks may ultimately prove beneficial for their cardiovascular health. (Circ Cardiovasc Qual Outcomes. 2011;4:293-299.
Stroke, 2012
on behalf of the PRIME Study Group Background and Purpose-To date, the association between depressive symptoms and the risk of cardiovascular diseases remains controversial. We investigated prospectively, within the same population, the time course of the association between baseline depressive symptoms and first stroke or coronary heart disease event. Methods-In the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study, a multicenter, observational, prospective cohort, 9601 men from France and Northern Ireland were surveyed for the occurrence of first coronary heart disease (nϭ647) and stroke events (nϭ136) over 10 years. At baseline, the fourth quartile of a 13-item modified Center for Epidemiological Studies questionnaire was used to define the presence of depressive symptoms. We sought the best time-dependent function to assess the association between depressive symptoms and outcomes. Thus, the hazard ratios were estimated by a Cox proportional hazard model after splitting the follow-up before and after 5 years of follow-up time periods. Results-Depressive symptoms at baseline were associated with coronary heart disease in the first 5 years of follow-up (hazard ratio, 1.43; 1.10 -1.87) and with stroke in the second 5 years of follow up (hazard ratio, 1.96; 1.21-3.19) after adjustment for age, study centers, baseline socioeconomic factors, traditional vascular risk factors, and antidepressant treatment. The association was even stronger for ischemic stroke (nϭ108; hazard ratio, 2.48; 1. 45-4.25). Conclusions-The current study suggests that in healthy, European, middle-aged men, baseline depressive symptoms are associated with an increased risk of coronary heart disease in the short-term, and for stroke in the long-term. (Stroke. 2012;43:00-00.) The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl/
Objective: To examine the relationship between depressive symptoms and all-cause mortality in a longitudinal study with a nationally representative sample. Research has shown that depressive symptoms increase mortality risk, but results have been inconclusive regarding the role of physical health conditions in the relationship. This study asks whether the association between depressive symptoms and mortality exists independent of contemporaneous physical health conditions, is spurious because of prior physical health conditions, or is mediated by later physical health conditions. Methods: Data are drawn from the Americans' Changing Lives Study, a sample of 3617 noninstitutionalized Americans aged 25 years or older. Respondents were interviewed in 1986Respondents were interviewed in , 1989Respondents were interviewed in , 1994Respondents were interviewed in , and 2002. Depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]), physical health, and confounders were measured at each wave. Mortality status was ascertained yearly through 2007. Discrete time hazard models with time-varying covariates were used to estimate the association between CES-D scores and mortality. Results: Between 1986 and 2007, 1411 survey respondents died. Depressive symptoms were associated with mortality after adjusting for stress, coping characteristics, social support, and health behaviors (odds ratio [OR] = 1.23, 95% confidence interval [CI] = 1.11Y1.36, p G .001). However, the association became nonsignificant after accounting for contemporaneous physical health conditions (OR = 1.06, 95% CI = 0.95Y1.17, p = .31). Prior physical health conditions did not explain the association (OR = 1.24, 95% CI = 1.11Y1.39, p G .001). The association between lagged depressive symptoms and mortality was mediated by later physical health conditions (p = .94). Conclusions: Study findings support the mediation hypothesis. The effect of depressive symptoms on mortality is mediated by later physical health.
Depressive Symptoms and Risk of Stroke
Stroke, 2006
Background and Purpose— Emerging evidence raises the possibility of an association between depression and stroke risk. This study sought to examine whether depressive symptoms are associated with an increased risk of cerebrovascular events in a community-based sample. Methods— A prospective study was conducted on 4120 Framingham Heart Study participants aged 29 to 100 years with up to 8 years of follow-up. The Center for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Incident stroke and transient ischemic attack (TIA) events were assessed by uniform diagnostic criteria. The association between depressive symptoms and risk of stroke/TIA was analyzed with Cox proportional-hazards models, after adjusting for traditional stroke risk factors. Results— In participants <65 years, the risk of developing stroke/TIA was 4.21 times greater ( P =<0.001) in those with symptoms of depression. After adjusting for components of the Framingham Stroke Risk Profi...