Effects of depressive symptoms and coronary heart disease and their interactive associations on mortality in middle-aged adults: the Whitehall II cohort study.: Depression and mortality by CHD status

Hermann Nabi 1, * Martin Shipley 2 Jussi Vahtera 3, 4 Martica Hall 5 Jyrki Korkeila 6 Michael Marmot 2 Mika Kivimäki 2, 4 Archana Singh-Manoux 1, 2, 7
* Auteur correspondant
1 CESP - Centre de recherche en épidémiologie et santé des populations
2 Department of Epidemiology and Public Health
3 Department of Public Health
4 Unit of Excellence for Psychosocial Factors
5 Department of Psychiatry [Pittsburgh]
6 Department of Psychiatry
7 Centre de Gérontologie
Abstract : BACKGROUND: Depression and mortality have been studied separately in patients with coronary heart disease (CHD) and in populations healthy at study inception. This does not allow comparisons across risk-factor groups based on the cross-classification of depression and CHD status. OBJECTIVE: To examine effects of depressive symptoms and CHD and their interactive associations on mortality in middle-aged adults followed over 5.6years. DESIGN AND SETTING: A prospective population-based cohort study of 5936 middle-aged men and women from the British Whitehall II study. We created four risk-factor groups based on the cross-classification of depressive symptoms and CHD status. RESULTS: The age-adjusted and sex-adjusted hazard ratios for death from all causes were 1.67 (p<0.05) for participants with only CHD, 2.10 (p<0.001) for those with only depressive symptoms and 4.99 (p<0.001) for those with both CHD and depressive symptoms when compared to participants without either condition. The two latter risk-factor groups remained at increased risk after adjustments for relevant confounders. The relative excess risk due to the interaction between depressive symptoms and CHD for all-cause mortality was 3.58 (95% CI -0.09 to 7.26), showing some evidence of an additive interaction. A similar pattern was also observed for cardiovascular death. CONCLUSIONS: This study provides evidence that depressive symptoms are associated with an increased risk of all-cause and cardiovascular death and that this risk is particularly marked in depressive participants with co-morbid CHD.
Keywords : Coronary heart disease depressive symptoms survival
Type de document :
Article dans une revue
Heart, BMJ Publishing Group, 2010, 96 (20), pp.1645-50. 〈10.1136/hrt.2010.198507〉
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Hermann Nabi, Martin Shipley, Jussi Vahtera, Martica Hall, Jyrki Korkeila, et al.. Effects of depressive symptoms and coronary heart disease and their interactive associations on mortality in middle-aged adults: the Whitehall II cohort study.: Depression and mortality by CHD status. Heart, BMJ Publishing Group, 2010, 96 (20), pp.1645-50. 〈10.1136/hrt.2010.198507〉. 〈inserm-00530265〉

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