Spousal cardiovascular events were associated with a heterogeneous risk of subsequent depression, with the most vulnerable group facing an increased risk (OR 1.38; 95% CI 1.01-1.88).
Cohort (n=59,900)
Yes
Does a spousal cardiovascular event increase the risk of subsequent depression in index individuals?
The risk of depression following a spouse's cardiovascular event is heterogeneous, with vulnerable groups facing a higher risk, highlighting the need for targeted interventions for family members.
Effect estimate: OR 1.38 (highest quartile) (95% CI 1.01-1.88)
Although previous studies have reported interpersonal associations between cardiovascular disease (CVD) and depression, evidence is lacking as to whether this association varies by individual characteristics. Using a nationwide database, we applied a sequential matching framework to construct a cohort of 59,900 index individuals (primary insured) whose spouses (dependent) received first CVD diagnosis and those without spouses’ CVD event between 2016 and 2018. We examined heterogeneity in the association between spousal CVD events and subsequent depression in index individuals within 3 years via a novel machine learning approach, Bayesian causal forest (BCF), adjusting for sociodemographic characteristics, comorbidities, health behaviors, and physical health conditions. We trained the BCF model using randomly selected 50 % sample and evaluated the heterogeneity by estimating conditional average treatment effect (CATE) using the remaining 50 % sample. Our BCF algorithm identified heterogeneity in the association between spouse's CVD and depression (the lowest quartile of CATE most resilient group, risk difference 95 %CI = −0.54 percentage point -1.24, 0.16 and odds ratio 95 %CI = 0.78 0.57, 1.07; and the highest quartile of CATE most vulnerable group, risk difference 95 %CI = +0.73 percentage point 0.02, 1.44 and odds ratio 95 %CI = 1.38 1.01, 1.88). Individuals with higher CATEs were more likely to have a higher proportion of females, have fewer disease histories, and have more frequent unhealthy behaviors. Most individuals were male (95 %), potentially limiting the generalizability. The depression risk associated with spouse's CVD varied across individuals. Future studies should elaborate on building targeted interventions to promote better health security of family members as well as patients with CVD. • Depression risks after spousal CVD events were heterogeneous across individuals. • Vulnerable groups had more females, fewer diseases, and more unhealthy behaviors. • Machine learning can uncover complex interactions between lifestyle and diseases. • Future studies should build targeted interventions for both patients and families.
Komura et al. (2025) conducted a cohort in Depression following spousal cardiovascular events (n=59,900). Spousal CVD event vs. No spousal CVD event was evaluated on Subsequent depression (OR 1.38 (highest quartile), 95% CI 1.01-1.88). Spousal cardiovascular events were associated with a heterogeneous risk of subsequent depression, with the most vulnerable group facing an increased risk (OR 1.38; 95% CI 1.01-1.88).