Depression and anxiety in a primary prevention study: a preliminary analysis from the REACT study

Background Depression and anxiety are associated with adverse cardiovascular outcomes and have been identified as priority targets for assessment and intervention in cardiovascular care (1). Despite this, systematic mental health assessment is not routinely integrated into cardiovascular screening programmes. The aim of this analysis was to characterise screening-based and self-reported history-based identification of depression and anxiety in a large multinational subclinical atherosclerosis cohort. Methods For this preliminary analysis, ~4200 asymptomatic adults (48% female, mean age 47±13 years) from the REACT study were included, a cross-sectional multicentre prevalence study of subclinical atherosclerosis conducted in two European countries. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and anxiety symptoms using the Generalised Anxiety Disorder-7 scale (GAD-7); participants scoring ≥10 on either instrument were considered screen-positive for the respective condition. Prior diagnosis or treatment history was defined as participant-reported history of a confirmed diagnosis or treatment for the respective condition at the time of screening. Co-occurring depression and anxiety were defined as concurrent PHQ-9 ≥10 and GAD-7 ≥10. Prevalence was stratified by country, sex, and age decade. Results Depression was identified in 8.3% and anxiety in 8.0% of participants overall. Across the full sample, 4.0% screened positive for depression only, 3.8% for anxiety only, and 4.2% for both simultaneously. Prevalence was highest among women aged 20–29 years for both conditions, and decreased with advancing age. In participants with no prior diagnosis or treatment history, 4.0% were screen-positive for depression and 3.3% for anxiety. Among all participants, 13.5% reported a prior history of depression while currently screen-negative, and 14.2% reported a prior anxiety history and were currently screen-negative. Conclusion In this preliminary analysis of a large, subclinical atherosclerosis cohort, depression and anxiety symptoms were identified in approximately 8% of adults, with co-occurring depression and anxiety in 4.2%, broadly in line with estimates reported in the general European adult population (2). Both conditions demonstrated peak prevalence among women aged 20–29 years, decreasing with advancing age. Of all participants, 4.0% were screen-positive for depression and 3.3% for anxiety with no reported prior history, while 13.5% and 14.2%, respectively, reported a prior history and were currently screen-negative.