The impact of mental vulnerability on the relationship between cardiovascular disease and depression

Abstract

Background. The mechanisms linking cardiovascular disease (CVD) and depression are still not established. We investigated the impact of mental vulnerability on the relationship between CVD and depression. Methods. A total of 19,856 individuals from five cohorts of random samples of the background population in Copenhagen were followed from baseline (1983–2011) until 2017 in Danish registries. Additive hazard and Cox proportional hazard models were used to analyze the effects of confounding by mental vulnerability as well as interactions between mental vulnerability and CVD on the risk of depression. Results. During follow-up, 15.3% developed CVD, while 18.1% experienced depression. A strong positive association between CVD and depression (hazard ratio: 3.60 [95% confidence intervals (CI): 3.30; 3.92]) corresponding to 35.4 (95% CI: 31.7; 39.1) additional cases per 1,000 person-years was only slightly attenuated after adjustment for mental vulnerability in addition to other confounders. Synergistic interaction between CVD and mental vulnerability was identified in the additive hazard model. Due to interaction between CVD and mental vulnerability, CVD was associated with 50.9 more cases of depression per 1,000 person-years among individuals with high mental vulnerability compared with individuals with low mental vulnerability. Conclusions. Mental vulnerability did not explain the strong relationship between CVD and depression. CVD was associated with additional cases of depression among individuals with higher mental vulnerability indicating that this group holds the greatest potential for intervention, for example, in rehabilitation settings.

Constructing a Nurse-led Cardiovascular Disease Intervention in Rural Ghana: A Qualitative Analysis

“…The high degree of readiness for change suggests these interventions could viably surmount those barriers in addressing not just blood pressure but CVD overall. If created in collaboration with community members and their leaders, this intervention could address not only classic CVD risk factors, such as tobacco use or hypertension, but also prevalent comorbid local risk factors, such as alcohol use disorder, depression, and other mental illness [23], which cause and are caused by CVD [42][43][44]. The prevalence of depression in persons in Ghana with hypertension, for example, may be as high as 41.7% [45].…”