Depressive symptoms were significantly associated with increased all-cause mortality (HR 1.10 per scale unit; 95% CI 1.04-1.16), with minimal mediation by inflammatory and cardiovascular risk markers.
Cohort (n=2,389)
Are depressive symptoms associated with all-cause mortality in middle-aged men, and is this mediated by inflammatory and cardiovascular risk factors?
Depressive symptoms are independently associated with increased all-cause mortality in middle-aged men, with inflammatory and cardiovascular biomarkers showing additive rather than mediating effects.
Hazard Ratio: 1.1 (95% CI 1.04–1.16)
OBJECTIVES: To improve understanding about the potential underlying biological mechanisms in the link between depression and all-cause mortality and to investigate the role that inflammatory and other cardiovascular risk factors may play in the relationship between depressive symptoms and mortality. METHODS: Depression and blood-based biological markers were assessed in the Belfast PRIME prospective cohort study (N = 2389 men, aged 50-59 years) in which participants were followed up for 18 years. Depression was measured using the 10-item Welsh Pure Depression Inventory. Inflammation markers (C-reactive protein CRP, neopterin, interleukin IL-1 receptor antagonist IL-1Ra, and IL-18) and cardiovascular-specific risk factors (N-terminal pro-b-type natriuretic peptide, midregion pro-atrial natriuretic peptide, midregion pro-adrenomedullin, C-terminal pro-endothelin-1 CT-proET) were obtained at baseline. We used Cox proportional hazards modeling to examine the association between depression and biological measures in relation to all-cause mortality and explore the mediating effects. RESULTS: During follow-up, 418 participants died. Higher levels of depressive symptoms were associated with higher levels of CRP, IL-1Ra, and CT-proET. After adjustment for socioeconomic and life-style risk factors, depressive symptoms were significantly associated with all-cause mortality (hazard ratio = 1.10 per scale unit, 95% confidence interval = 1.04-1.16). This association was partly explained by CRP (7.3%) suggesting a minimal mediation effect. IL-1Ra, N-terminal pro-b-type natriuretic peptide, midregion pro-atrial natriuretic peptide, midregion pro-adrenomedullin, and CT-proET contributed marginally to the association between depression and subsequent mortality. CONCLUSIONS: Inflammatory and cardiovascular risk markers are associated with depression and with increased mortality. However, depression and biological measures show additive effects rather than a pattern of meditation of biological factors in the association between depression and mortality.
Hughes et al. (Thu,) conducted a cohort in Depression (n=2,389). Depressive symptoms vs. Lower levels of depressive symptoms was evaluated on All-cause mortality (HR 1.10, 95% CI 1.04-1.16). Depressive symptoms were significantly associated with increased all-cause mortality (HR 1.10 per scale unit; 95% CI 1.04-1.16), with minimal mediation by inflammatory and cardiovascular risk markers.
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