Relationship of non-melancholic and melancholic depressive symptoms with all-cause mortality: A prospective study in a primary care population.

OBJECTIVE: To assess relationship of non-melancholic and melancholic subtypes of depressive symptoms with all-cause mortality among cardiovascular risk persons. METHODS: A population-based prospective study of 2522 Finnish middle-aged persons with elevated cardiovascular risk was conducted. Depressive symptoms were assessed by the Beck's Depression Inventory. Data on mortality were obtained from The Official Statistics of Finland after 11-year follow-up. RESULTS: At baseline, the prevalence of non-melancholic and melancholic depressive symptoms was 14.9% and 5.2%, respectively. During the mean follow-up time of 11 years, 8.1% (n = 164) of those without, 13.9% (n = 52) of those with non-melancholic, and 10.7% (n = 14) of those with melancholic depressive symptoms died. Compared to non-depressive subjects, the hazard ratio for time to all-cause mortality was 1.67 (95% CI: 1.21-2.32, p = .002) in non-melancholically depressive and 1.01 (95% CI: 0.56-1.83, p = .97) in melancholically depressive subjects, when adjusted for age, gender, education, smoking, alcohol use, BMI, hypertension, dyslipidaemia, and glucose disorders. In comparison to the mortality rate in the general population throughout Finland over the same period, non-depressiveness was associated with a decreased standardized mortality rate. CONCLUSION: Non-melancholic depressive symptoms seem to be associated with excess all-cause mortality. In clinical settings, recognition of non-melancholic depressive symptoms should be emphasised.

Non-melancholic depressive symptoms increase risk for incident cardiovascular disease: A prospective study in a primary care population at risk for cardiovascular disease and type 2 diabetes.

OBJECTIVE: To assess subtypes of depressive symptoms and their relationship with cardiovascular disease (CVD) morbidity among CVD risk persons. METHODS: A prospective study of 2522 CVD risk persons was conducted. Non-melancholic and melancholic depressive symptoms were assessed by Beck's Depression Inventory. Data on incident CVD was gathered from a national register, after 8 years of follow-up. RESULTS: At baseline, the prevalence of non-melancholic and melancholic depressive symptoms was 14.9% and 5.2%, respectively. A total of 18,413 person-years was followed up, and the incidence of CVD was 9.6% in non-depressive, 14.1% in non-melancholically depressive, and 13.0% in melancholically depressive subjects. When adjusted for age, gender, education, smoking, alcohol use, leisure-time physical activity, hypertension, and dyslipidemia, the incidence rate ratios (IRR) for CVD in subjects with non-melancholic and melancholic depressive symptoms compared to non-depressiveness were IRR 1.69 (95% CI: 1.23-2.31) and IRR 1.31 (95% CI: 0.75-2.26). CONCLUSION: Non-melancholic depressive symptoms seem to increase risk for incident CVD among CVD risk subjects. Considering non-melancholic depressive symptoms might be useful when treating subjects with other CVD risk factors.

Poor or fair self-rated health is associated with depressive symptoms and impaired perceived physical health: A cross-sectional study in a primary care population at risk for type 2 diabetes and cardiovascular disease.

Background: Psychosocial factors such as depressive symptoms should be considered when assessing cardiovascular (CV) risk. Depressive symptoms are suggested to be associated with poor perception of one's health, i.e. self-rated health (SRH). Thus, assessing SRH could be a practical tool in CV risk prediction. However, SRH may also emphasize physical, mental or social aspects. Objectives: To assess the relationship of SRH and depressive symptoms, classic CV risk factors and perceived physical health among persons at risk for type 2 diabetes (T2D) and cardiovascular disease (CVD). Methods: In this cross-sectional study in a primary care population, 2555 persons (mean age 58 ± 7, 56% women) at risk for T2D or CVD were evaluated. Generalized linear statistical models were used to evaluate the association of depressive symptoms (Beck's Depression Inventory score ≥10), CV risk factors, and perception of SRH and physical health (assessed by Short Form Health Survey). Results: Poor or fair health was reported by 40% of the participants. They had more unhealthy lifestyle habits and CV risk factors than subjects rating their health as at least good. Among those with poor or fair SRH, the prevalence of depressive symptoms was 36% and associated with perception of physical health. Conclusion: Poor SRH is associated with depressive symptoms and impaired perceived physical health. Assessing SRH might be useful for detecting possible depressive symptoms in patients in CV risk management and diabetes care.

Awareness of hypertension and depressive symptoms: a cross-sectional study in a primary care population.

OBJECTIVE: To investigate the association of hypertension awareness and depressive symptoms, and to analyse factors predisposing aware hypertensives to depressive symptoms. DESIGN: Cross-sectional study in a primary care population. SETTING: Cardiovascular risk factor survey in two semi-rural towns in Finland. SUBJECTS: Two thousand six hundred seventy-six middle-aged risk persons without an established cardiovascular or renal disease or type 2 diabetes. MAIN OUTCOME MEASURES: Depressive symptoms, previous and new diagnosis of hypertension. RESULTS: Hypertension was diagnosed in 47.9% of the subjects, of whom 34.5% (442/1 282) had previously undetected hypertension. Depressive symptoms were reported by 14% of the subjects previously aware of their hypertension, and by 9% of both unaware hypertensives and normotensive subjects. In the logistic regression analysis, both the normotensive (OR 0.62, 95% CI 0.45-0.86) (p = 0.0038) and the unaware hypertensive subjects (OR 0.54, 95% CI 0.35-0.84) (p = 0.0067) had lower risk for depressive symptoms than the previously diagnosed hypertensives. Among these aware hypertensives, female gender (OR 3.61, 95% CI 2.06-6.32), harmful alcohol use (OR 2.55, 95% CI 1.40-4.64) and obesity (OR 2.50, 95% CI 1.01-6.21) predicted depressive symptoms. Non-smoking (OR 0.57, 95% Cl 0.33-0.99) and moderate leisure-time physical activity compared to low (OR 0.53, 95% CI 0.33-0.84) seemed to buffer against depressive symptoms. CONCLUSION: Depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle associated factors may contribute to the association of hypertension and depressive symptoms. Key Points Hypertension and depressive symptoms are known to form a toxic combination contributing even to all-cause mortality. Comorbidities or the labelling effect of the diagnosis of hypertension can confound their association. Our study shows that depressive symptoms are common in hypertensive persons even without comorbidities, if the person is already aware of his/her hypertension. Many modifiable, lifestyle-associated factors may contribute to the association of hypertension and depressive symptoms. When treating hypertensive patients, consideration of depressive symptoms is important in order to promote favorable lifestyle and control of hypertension.