Depression Linked to All-Cause and Cardiovascular Mortality

Treating depression could yield better cardiovascular results, according to a new study based in China.

A team, led by Ruiwei Meng, PhD, School of Public Health at Huazhong University of Science and Technology, examined whether depression is linked to the risk of all-cause and cardiovascular disease mortality in Chinese adults.

Depression is often association with increased disease burden globally, with a higher risk of mortality found in Western populations.

In the cohort study, the investigators examined the data from 512,713 adults from the China Kadoorie Biobank (CKB) study and 26,298 adults from the Dongfen-Tongji (DFTJ) study.

The China Kadoorie Biobank study took place between June 2004 and December 2016 with patients ranging between 30-79 years old. The Dongfen-Tongji study took place between September 2008 and December 2016 with participants between 32-104 years old.

In the China Kadoorie Biobank study, there were 44,065 deaths, including 18,273 cardiovascular deaths, while there were 2571 deaths in the Dongfen-Tongji cohort, including 1013 cardiovascular deaths.

The investigators evaluated depression using the Chinese version of the World Health Organization Composite International Diagnostic Interview-Short Form in the China Kadoorie Biobank study and a 7-item symptoms questionnaire modified from the Composite International Diagnostic Interview-Short Form in the Dongfen-Tongji study.

They then used multivariable-adjusted Cox proportional hazards regression models to estimate hazard ratios and the 95% confidence intervals for the association of depression with mortality.

The team also included sociodemographic characteristics, lifestyle factors, and personal and family medical history in their final models.

The one-year prevalence of major depressive episodes was .64% in the first study and 1-month prevalence of clinically significant depressive symptoms was 17.96% in the second cohort.

In the multivariable-adjusted model, depression was linked to an increased risk of all-cause mortality (CKB cohort: HR, 1.32; 95% CI, 1.20-1.46; P&thinsp;<.001; DFTJ cohort: HR, 1.17, 95% CI, 1.06-1.29; P&thinsp;=&thinsp;.002), and cardiovascular mortality (CKB cohort: HR, 1.22; 95% CI, 1.04-1.44; P&thinsp;=&thinsp;.02; DFTJ cohort: HR, 1.32; 95% CI, 1.14-1.54; P&thinsp;<.001).

In both cohorts, men had statistically significantly higher all-cause mortality risk (CKB cohort: HR, 1.53; 95% CI, 1.32-1.76; DFTJ cohort: HR, 1.24; 95% CI, 1.10-1.41), and CVD mortality (CKB cohort: HR, 1.39; 95% CI, 1.10-1.76; DFTJ cohort: HR, 1.49; 95% CI, 1.23-1.80).

The link between depression with mortality among women was only significantly for all-cause mortality in the CKB cohort (HR, 1.19; 95% CI, 1.03-1.37).

While the findings show depression is consistently linked to higher risk of all-cause and cardiovascular disease mortality, when stratified by sex, the associations were only significant in men.

“These findings suggest that depression is associated with an increased risk of all-cause and [cardiovascular] mortality in adults in China, particularly in men,” the authors wrote. “These findings highlight the importance and urgency of depression management as a measure for preventing premature deaths in China.”

Officials estimate that more than 10 million disability-adjusted life-years was associated with depressive disorders in China in 2013, with the number projected to increase approximately 10% by 2025.

The study, “Association of Depression With All-Cause and Cardiovascular Disease Mortality Among Adults in China,” was published online in JAMA Network Open.