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

Abstract

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.

Major depression, physical health and molecular senescence markers abnormalities

“…In individuals with LLD, the SASP index was most strongly associated with the cardiovascular and cardiometabolic health factor. Previous studies have demonstrated a robust bidirectional relationship between LLD and physical health 6 and the mediating effect of medical conditions on treatment outcomes 45 . One previous study in young and middle-aged adults with major depressive disorder demonstrated that the SASP index was most strongly correlated to BMI 31 .…”

Role of handgrip strength in predicting new-onset diabetes: findings from the survey of health, ageing and retirement in Europe

“…Finally, when the accurate onset time of some diabetes patients was unavailable, we approximated the onset time using the midpoint time. Although this method has been adopted by many studies [41,42], the accuracy of the onset time could not be fully guaranteed and the measurement error might be introduced.…”

PHQ-9, CES-D, health insurance data—who is identified with depression? A Population-based study in persons with diabetes

“…The results of our study show that between 14·6% and 22·4% of individuals with diabetes had depression depending on the method used to assess it. High prevalence estimates can be expected, since on the one hand, there is evidence that depression is a risk factor for diabetes and, on the other hand, studies show that the distress caused by diabetes contributes to the development of depression [ 1 , 8 , 33 – 36 ]. The results of our study are within the range of findings from the two most recent meta-analyses on depression among persons with diabetes where prevalence ranged from 1·8% up to 88·0% [ 1 , 8 ].…”