Multiple Traumas Accelerate the Transition From Cardiovascular Disease to Depression: A Multistate Study

BACKGROUND: Traumas are risk factors for both cardiovascular disease (CVD) and depression. However, the specific impacts of trauma on the critical transition from incident CVD to subsequent depression and mortality remain scarce. METHODS: =138 036), we constructed multistate models to investigate the associations of childhood trauma, adult trauma, and lifetime trauma with the transitions between health states. Specifically, we modeled transitions from a healthy state to incident CVD, further to subsequent depression, and ultimately to death. RESULTS: Over a median follow-up of 13.65 years, 14 278 participants developed incident CVD, with 679 developed subsequent depression and 4144 dying. Trauma was positively associated with the dynamic disease progression: the transition from baseline to incident CVD showed significantly elevated hazards for multiple childhood traumas (hazard ratio [HR], 1.294 [95% CI, 1.170-1.432]), adult traumas (HR, 1.145 [95% CI, 1.071-1.225]), and lifetime traumas (HR, 1.632 [95% CI, 1.528-1.742]) compared with no trauma exposure. Similarly, the transition from incident CVD to subsequent depression demonstrated increased risks for multiple childhood traumas (HR, 2.260 [95% CI, 1.661-3.075]), adult traumas (HR, 1.950 [95% CI, 1.510-2.518]), and lifetime traumas (HR, 1.608 [95% CI, 1.245-2.078]) versus no trauma exposure. CONCLUSIONS: These findings demonstrate that exposure to multiple traumas significantly increases the risk of developing depression following an incident CVD diagnosis. This underscores the urgent need for clinical and public health interventions targeting multiple traumas to mitigate the risk of CVD and depression progression, thereby improving outcomes.