Trajectories of depressive symptoms and risk of cardiovascular disease: Evidence from the China Health and Retirement Longitudinal Study

Longyang Han; Suwen Shen; Yu Wu; Chongke Zhong; Xiaowei Zheng

doi:10.1016/j.jpsychires.2021.12.017

Trajectories of depressive symptoms and risk of cardiovascular disease: Evidence from the China Health and Retirement Longitudinal Study

J Psychiatr Res. 2021 Dec 14:145:137-143. doi: 10.1016/j.jpsychires.2021.12.017. Online ahead of print.

Authors

Longyang Han¹, Suwen Shen², Yu Wu¹, Chongke Zhong³, Xiaowei Zheng⁴

Affiliations

¹ Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine Jiangnan University, Wuxi, Jiangsu, 214122, China.
² Wuxi Municipal Center for Disease Control and Prevention, Wuxi, Jiangsu, 214023, China.
³ Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, 215000, China. Electronic address: ckzhong@suda.edu.cn.
⁴ Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine Jiangnan University, Wuxi, Jiangsu, 214122, China. Electronic address: zxw19921212@163.com.

PMID: 34922097
DOI: 10.1016/j.jpsychires.2021.12.017

Abstract

Background: Previous studies have reported that depression is associated with higher risk of cardiovascular disease (CVD). However, the association between long-term depressive symptom patterns and the risk of CVD was not well characterized.

Methods: A total of 8621 participants with three Center for Epidemiological Studies Depression Scale (CES-D) measurements from the China Health and Retirement Longitudinal Study were included. Trajectories of depressive symptoms were identified by latent mixture modeling. Cox proportional hazards regression models were used to examine the association of depressive symptom trajectories with CVD (stroke or cardiac events), and accounting for mortality as a competing risk for CVD.

Results: We identified four distinct depressive symptoms trajectories, characterized by maintaining low CES-D score throughout the follow-up (no depressive symptoms; 5642 participants [65.44%]); high starting CES-D scores but then decreasing scores (decreasing depressive symptoms; 1329 participants [14.91%]); low starting CES-D scores then increasing scores (increasing depressive symptoms; 1154 participants [13.39%]) and maintained high CES-D scores throughout the follow-up (persistent depressive symptoms; 496 participants [6.26%]). During the follow-up period, 853 CVD events (including 362 strokes and 535 cardiac events) were recorded. Compared to participants in the no depressive symptom trajectory, those in the increasing depressive symptoms and persistent depressive symptom trajectories had an increased risk of CVD, with multiple-adjusted hazard ratios (95% confidence intervals) of 1.53 (1.28-1.82) and 1.68 (1.34-2.12), respectively. Individuals with increasing and persistent depressive symptoms trajectories also had higher risks of stroke and cardiac events.

Conclusions: Individuals with increasing and persistent depressive symptom over time were associated with increased risk of incident CVD.

Keywords: CVD; Cardiac events; Depressive symptoms; Stroke; Trajectory.