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Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries

Rajan S 1 , McKee M 1 , Rangarajan S 2 , Bangdiwala S 2 , Rosengren A 3 , Gupta R 4 Show all authors , Kutty VR 5 , Wielgosz A 6 , Lear S 7 , AlHabib KF 8 , Co HU 9 , Lopez-Jaramillo P 10 , Avezum A 11 , Seron P 12 , Oguz A 13 , Kruger IM 14 , Diaz R 15 , Nafiza MN 16 , Chifamba J 17 , Yeates K 18 , Kelishadi R 19 , Sharief WM 20 , Szuba A 21 , Khatib R 22 , Rahman O 23 , Iqbal R 24 , Bo H 25 , Yibing Z 25 , Wei L 25 , Yusuf S 2 , Prospective Urban Rural Epidemiology (PURE) Study Investigators

Affiliations 

  • 1 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, United Kingdom
  • 2 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
  • 3 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Sweden
  • 4 Eternal Heart Care Centre & Research Institute, Jaipur, India
  • 5 Health Action by People, Trivandrum, India
  • 6 Department of Medicine, University of Ottawa, Ontario, Canada
  • 7 Faculty of Health Sciences, Simon Fraser University, Burnaby, Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
  • 8 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 9 University of the Philippines College of Medicine, Manila, Philippines
  • 10 Masira Research Institute, Medical School, Universidad de Santander (UDES), FOSCAL, Bucaramanga, Colombia
  • 11 Department of Medicine, Universidade de Santo Amaro, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
  • 12 Universidad de La Frontera, Temuco, Chile
  • 13 Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
  • 14 Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
  • 15 Estudios Clínicos Latinoamérica (ECLA), Rosario, Santa Fe, Argentina
  • 16 Faculty of Medicine, UiTM, Malaysia
  • 17 University of Zimbabwe College of Health Sciences, Department of Physiology, Harare, Zimbabwe
  • 18 Department of Medicine, Queen's University, Kingston, Ontario, Canada
  • 19 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 20 Department of Medicine, Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  • 21 Department of Angiology, Wroclaw Medical University, Poland
  • 22 Advocate Research Institute, Advocate Health Care, Downers Grove, Illinois
  • 23 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
  • 24 Independent University, Bangladesh, Dhaka, Bangladesh
  • 25 National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
JAMA Psychiatry, 2020 10 01;77(10):1052-1063.
PMID: 32520341 DOI: 10.1001/jamapsychiatry.2020.1351

Abstract

Importance: Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live.

Objective: To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas.

Design, Setting, and Participants: This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019.

Exposures: Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview.

Main Outcomes and Measures: Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality.

Results: Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [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, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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