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

Abstract

ObjectiveTo assess the association between time-varying depressive symptoms with all-cause and cause-specific mortality.DesignThe REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a national, population-based longitudinal study conducted from 2003 to 2007.SettingGeneral continental US communities.Participants29 491 black and white US adults ≥45 years randomly sampled within race–sex–geographical strata.ExposureElevated depressive symptoms (Centre for Epidemiologic Studies Depression (CES-D) 4≥4) measured at baseline and on average 5 and 7 years later.Main outcome measuresCox proportional hazard regression models assessed cancer, non-cardiovascular (cardiovascular disease (CVD)), CVD and all-cause mortality.ResultsThe average age was 64.9 years; 55% were women; 41% black; 11.0% had elevated depressive symptoms; 54% had poor, fair or good health. Time-varying depressive symptoms were significantly associated with non-CVD (adjusted HR (aHR)=1.29, 95% CI 1.16 to 1.44) and all-cause (aHR=1.24, 95% CI 1.14 to 1.39), but not cancer (aHR=1.15, 95% CI 0.96 to 1.38) or CVD (aHR=1.13, 95% CI 0.98 to 1.32) death adjusting for demographics, chronic clinical diseases, behavioural risk factors and physiological factors. Depressive symptoms were related to all-cause (aHR=1.48, 95% CI 1.27 to 1.78), CVD (aHR=1.37, 95% CI 0.99 to 1.91), non-CVD (aHR=1.54, 95% CI 1.24 to 1.92) and cancer (aHR=1.36, 95% CI 0.97 to 1.91) death in those who reported excellent or very good health. The analyses of the association between one measure of baseline depressive symptoms and mortality analyses yielded similar results.ConclusionsTime-varying depressive symptoms confer an increased risk for all-cause mortality, CVD, non-CVD death and cancer death, particularly in those with excellent or very good health. These findings may have implications for timely treatment, regardless of health status.

Contribution of psychosocial factors to socioeconomic inequalities in mortality among older Australian men: a population-based cohort study

“…Strong associations between elevated depressive symptoms and deaths from all-causes, CVD, and non-CVD, non-cancer in our study agree with previous studies among older adults [ 40 – 42 ]. Behavioural mechanisms could be a potential explanation for the association between depression and all-cause and CVD mortality; depressed individuals are more likely to be physically inactive, to smoke, and to have unhealthy diet [ 43 ].…”

Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009–2014

“…Individuals with depression are more likely to experience social isolation, decreased work performance, anxiety, and substance use disorder, and are more likely to attempt suicide [13][14][15]. They are also more likely to develop cardiovascular disease and diabetes, and have higher all-cause mortality than individuals without depression [19,[48][49][50][51]. Productive years lost due to disability from depression are greater than those from diabetes, cardiovascular disease, and cancer [52].…”

Racial differences in weathering and its associations with psychosocial stress: The CARDIA study

“…Although previous research has shown differential effects of race and sex with depressive symptoms on aortic calcification (Lewis, Everson-Rose, Colvin, Matthews, Bromberger & Sutton-Tyrrell, 2009), relationships specifically to weathering have not been shown. It is well-known that depression is associated with poor health, both prospectively (Moise, Khodneva, Jannat-Khah, Richman, Davidson & Kronish, 2018) and retrospectively, but relatively little is known about racial differences in these associations. One observational study found that retrospective and prospective associations between depressive symptoms and number of chronic medical conditions were present for Whites, but not Blacks (Assari et al, 2015) Other recent observational studies have found that depressive symptoms were more predictive of mortality in Whites than Blacks (Assari, 2018, Assari et al, 2016) but a different observational study found that depressive symptoms were associated with incident coronary heart disease in Blacks but not Whites (Sims, Redmond, Khodneva, Durant, Halanych & Safford, 2015).…”