What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular disease (n=9049). Intervention: Depressive symptoms vs. No depressive symptoms. Primary outcome: Self-reported cardiovascular disease (AOR 1.56, 95% CI 1.18-2.05, p=0.002).

February 1, 2025Open Access

Comparing the Association Between Depressive Symptoms and Cardiovascular Disease Among the Middle-Aged and Elderly Population: A National Survey of 9,049 Subjects Based on the Indonesian Family Life Survey-5

Key Result

Depressive symptoms were associated with significantly higher odds of self-reported cardiovascular disease (AOR 1.56) compared to having no depressive symptoms.

Study Design

Type

Cross-Sectional (n=9,049)

Structured PICO

Does the presence of depressive symptoms increase the risk of self-reported cardiovascular disease in middle-aged and elderly populations?

Population

9,049 adults aged 45 years and older from Indonesia were assessed to evaluate the association between depressive symptoms and self-reported cardiovascular disease.

Exposure

Presence of depressive symptoms (assessed using a modified Center for Epidemiologic Studies Depression CESD-R-10 scale)

Comparator

Absence of depressive symptoms

Outcome

Self-reported cardiovascular disease (CVD)patient reported

Depressive symptoms are significantly associated with an increased risk of self-reported cardiovascular disease in the Indonesian population, particularly among the elderly.

Main Result

Odds Ratio: 1.56 (95% CI 1.18–2.05)

p-value: p=0.002

Limitations

Depressive symptoms and CVD were assessed through self-reporting, which may introduce recall and misclassification biases
Cross-sectional design cannot establish absolute causality or directional association
Unmeasured factors such as duration and severity of depressive symptoms and CVD, physical activity, and comorbidities were not accounted for

Abstract

Introduction: The association between depressive symptoms and cardiovascular disease (CVD) is widely acknowledged. However, there is a lack of relevant evidence among the middle-aged population in developing countries where depressive symptoms often go undetected and untreated. The objectives of this study were to assess the association between depressive symptoms and CVD in Indonesia and to compare the association between the middle-aged and elderly population. Methods: This national cross-sectional population-based survey used secondary data from the publicly available Indonesian Family Life Survey (IFLS-5). Depressive symptoms were assessed using a modified Center for Epidemiologic Studies Depression (CESD-R-10) scale, and data on CVD and sociodemographic variables were self-reported. Binary logistic regression was performed to determine the association between depressive symptom and self-reported CVD after adjusting for confounding factors, with an adjusted odds ratio (AOR) and 95% confidence interval (CI) reported. Subgroup analysis was performed based on the age group. Results: The study included 9049 respondents, predominantly the middle-aged (71.1%), female (52.6%), elementary school graduates (50.7%), non-smokers (59.0%), non-obese (77.3%), without depressive symptoms (82.2%), and without self-reported CVD (96.7%). Respondents with depressive symptoms were more likely to experience self-reported CVD (AOR = 1.56; 95% CI = 1.18-2.05; p-value = 0.002), after adjusting for potential confounders. A significant association was observed between depressive symptoms and self-reported CVD in elderly respondents (AOR = 1.89; 95% CI = 1.22-2.94; p-value = 0.005), whereas no significant association was observed in the middle-aged group (AOR = 1.39; 95% CI = 0.98-1.98; p-value = 0.063) after adjusting for confounders. Conclusion: Respondents with depressive symptoms were associated with an increased risk of self-reported CVD, highlighting the urgent need for targeted prevention strategies, especially for those struggling with depressive symptoms.

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