Article

Systematic reviews examining associations of depressive disorder with
coronary heart disease and stroke produce mixed results. Failure to consider
reverse causation and dose-response patterns may have caused inconsistencies in
evidence. DESIGN: This prospective cohort study on depressive disorder, coronary
heart disease, and stroke analysed reverse causation and dose-response effects
using four 5-year and three 10-year observation cycles (total follow up 24 years)
based on multiple repeat measures of exposure. METHODS: Participants in the
Whitehall II study (n = 10,036, 31,395 person-observations, age at start 44.4
years) provided up to six repeat measures of depressive symptoms via the 30-item
General Health Questionnaire (GHQ-30) and one measure via Center for
Epidemiologic Studies Depression Scale (CES-D). The cohort was followed up for
major coronary events (coronary death/nonfatal myocardial infarction) and stroke
(stroke death/morbidity) through the national mortality register Hospital Episode
Statistics, ECG-screening, medical records, and self-report questionnaires.
RESULTS: GHQ-30 caseness predicted stroke over 0-5 years (age-, sex- and
ethnicity-adjusted HR 1.60, 95% CI 1.1-2.3) but not over 5-10 years (HR 0.94, 95%
CI 0.6-1.4). Using the last 5-year observation cycle, cumulative GHQ-30 caseness
was associated with incident coronary heart disease in a dose-response manner
(1-2 times a case: HR 1.12, 95% CI 0.7-1.7; 3-4 times: HR 2.06, 95% CI 1.2-3.7),
and CES-D caseness predicted coronary heart disease (HR 1.81, 95% CI 1.1-3.1).
CONCLUSIONS: There was evidence of a dose-response effect of depressive symptoms
on risk of coronary heart disease. In contrast, prospective associations of
depressive symptoms with stroke appeared to arise wholly or partly through
reverse causation.

Langue : ANGLAIS