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Time-dependent cognitive and somatic symptoms of depression as predictors of new cardiac-related events in at-risk patients: the UPBEAT-UK cohort

Published online by Cambridge University Press:  30 January 2020

J. Norton ,
M. Pastore ,
M. Ancelin ,
M. Hotopf ,
A. Tylee ,
A. Mann  and
J. Palacios
J. Norton*
Affiliation:
Inserm U1061, Montpellier, France University of Montpellier, Montpellier, France
M. Pastore
Affiliation:
University of Montpellier, Montpellier, France StatABio, CNRS, INSERM, Montpellier, France
M. Ancelin
Affiliation:
Inserm U1061, Montpellier, France University of Montpellier, Montpellier, France
M. Hotopf
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK South London and Maudsley NHS Foundation Trust, London, UK
A. Tylee
Affiliation:
Department of Health Services and Population Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
A. Mann
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
J. Palacios
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
*
Author for correspondence: J. Norton, E-mail: [email protected]
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Abstract

Background

Evidence suggests that somatic rather than cognitive depressive symptoms are risk factors for recurrent cardiac events in at-risk patients. However, this has never been explored using a time-dependent approach in a narrow time-frame, allowing a cardiac event-free time-window.

Methods

The analysis was performed on 595 participants [70.6% male, median age 72 (27–98)] drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Depressive symptomatology was measured using the Patient Health Questionnaire-9 (PHQ-9) (four somatic, five cognitive items). New cardiac events (NCEs) including cardiac-related mortality were identified by expert examination of patient records. Analyses were performed using Cox proportional hazard models with delayed entry, with time-dependent depressive dimensions and covariates measured 12–18 months (median: 14.1, IQR: 3.5) prior to the event, with a 12-month cardiac event-free gap.

Results

There were 95 NCEs during the follow-up [median time-to-event from baseline: 22.3 months (IQR: 13.4)]. Both the somatic (HR 1.12, 95% CI 1.05–1.20, p = 0.001) and cognitive dimensions (HR 1.11, 95% CI 1.03–1.18, p = 0.004) were time-dependent risk factors for an NCE in the multi-adjusted models. Specific symptoms (poor appetite/overeating for the somatic dimension, hopelessness and feeling like a failure for the cognitive dimension) were also significantly associated.

Conclusion

This is the first study of the association between depressive symptom dimensions and NCEs in at-risk patients using a time-to-event standardised approach. Both dimensions considered apart were independent predictors of an NCE, along with specific items, suggesting regular assessments and tailored interventions targeting specific depressive symptoms may help to prevent NCEs in at-risk populations.

Keywords

Cardiac diseasecardiac-related mortalityrecurrent cardiac eventsomatic and cognitive symptoms of depressiontime-dependent risk factors
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 8 , June 2021 , pp. 1271 - 1278
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Copyright
Copyright © Cambridge University Press 2020

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References

Andreescu, C., Chang, C. C., Mulsant, B. H., & Ganguli, M. (2008). Twelve-year depressive symptom trajectories and their predictors in a community sample of older adults. International Psychogeriatrics, 20, 221–236.CrossRefGoogle Scholar
Braam, A. W., Copeland, J. R., Delespaul, P. A., Beekman, A. T., Como, A., Dewey, M., … Skoog, I. (2014). Depression, subthreshold depression and comorbid anxiety symptoms in older Europeans: Results from the EURODEP concerted action. Journal of Affective Disorders, 155, 266–272.CrossRefGoogle ScholarPubMed
Carney, R. M., & Freedland, K. E. (2012a). Are somatic symptoms of depression better predictors of cardiac events than cognitive symptoms in coronary heart disease? Psychosomatic Medicine, 74, 33–38.CrossRefGoogle Scholar
Carney, R. M., & Freedland, K. E. (2012b). Is there a high-risk subtype of depression in patients with coronary heart disease? Current Psychiatry Reports, 14, 1–7.CrossRefGoogle Scholar
Connerney, I., Sloan, R. P., Shapiro, P. A., Bagiella, E., & Seckman, C. (2010). Depression is associated with increased mortality 10 years after coronary artery bypass surgery. Psychosomatic Medicine, 72, 874–881.CrossRefGoogle ScholarPubMed
Corney, R. H., & Clare, A. W. (1985). The construction, development and testing of a self-report questionnaire to identify social problems. Psychological Medicine, 15, 637–649.CrossRefGoogle ScholarPubMed
de Jonge, P., Mangano, D., & Whooley, M. A. (2007). Differential association of cognitive and somatic depressive symptoms with heart rate variability in patients with stable coronary heart disease: Findings from the Heart and Soul Study. Psychosomatic Medicine, 69, 735–739.CrossRefGoogle ScholarPubMed
de Jonge, P., Ormel, J., van den Brink, R. H., van Melle, J. P., Spijkerman, T. A., Kuijper, A., … Schene, A. H. (2006). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry, 163, 138–144.CrossRefGoogle ScholarPubMed
de Miranda Azevedo, R., Roest, A. M., Hoen, P. W., & de Jonge, P. (2014). Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: A meta-analysis. Psychological Medicine, 44, 2689–2703.CrossRefGoogle ScholarPubMed
Denollet, J., Freedland, K. E., Carney, R. M., de Jonge, P., & Roest, A. M. (2013). Cognitive-affective symptoms of depression after myocardial infarction: Different prognostic importance across age groups. Psychosomatic Medicine, 75, 701–708.CrossRefGoogle ScholarPubMed
Freedland, K. E., & Carney, R. M. (2013). Depression as a risk factor for adverse outcomes in coronary heart disease. BMC Medicine, 11, 131.CrossRefGoogle ScholarPubMed
Haddad, M., Walters, P., Phillips, R., Tsakok, J., Williams, P., Mann, A., & Tylee, A. (2013). Detecting depression in patients with coronary heart disease: A diagnostic evaluation of the PHQ-9 and HADS-D in primary care, findings from the UPBEAT-UK study. PLoS ONE, 8, e78493.CrossRefGoogle ScholarPubMed
Hoen, P. W., Conradi, H. J., Denollet, J., Martens, E. J., & de Jonge, P. (2010a). Interview-based ratings of somatic and cognitive symptoms of depression and their impact on cardiovascular prognosis. Psychotherapy and Psychosomatics, 79, 319–320.CrossRefGoogle Scholar
Hoen, P. W., Whooley, M. A., Martens, E. J., Na, B., van Melle, J. P., & de Jonge, P. (2010b). Differential associations between specific depressive symptoms and cardiovascular prognosis in patients with stable coronary heart disease. Journal of the American College of Cardiology, 56, 838–844.CrossRefGoogle Scholar
Kaup, A. R., Byers, A. L., Falvey, C., Simonsick, E. M., Satterfield, S., Ayonayon, H. N., … Yaffe, K. (2016). Trajectories of depressive symptoms in older adults and risk of dementia. JAMA Psychiatry, 73, 525–531.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Lamarca, R., Alonso, J., Gomez, G., & Munoz, A. (1998). Left-truncated data with age as time scale: An alternative for survival analysis in the elderly population. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 53, M337–M343.CrossRefGoogle ScholarPubMed
Lewis, G., Pelosi, A. J., Araya, R., & Dunn, G. (1992). Measuring psychiatric disorder in the community: A standardized assessment for use by lay interviewers. Psychological Medicine, 22, 465–486.CrossRefGoogle ScholarPubMed
Li, H., Van Halm-Lutterodt, N., Zheng, D., Liu, Y., Guo, J., Feng, W., … Guo, X. (2018). Time-dependent depressive symptoms and risk of cardiovascular and all-cause mortality among the Chinese elderly: The Beijing Longitudinal Study of Aging. Journal of Cardiology, 72, 356–362.CrossRefGoogle ScholarPubMed
Linke, S. E., Rutledge, T., Johnson, B. D., Vaccarino, V., Bittner, V., Cornell, C. E., … Bairey Merz, C. N. (2009). Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: A report from the national heart, lung, and blood institute-sponsored women's ischemia syndrome evaluation. Archives of General Psychiatry, 66, 499–507.CrossRefGoogle ScholarPubMed
Martens, E. J., Denollet, J., Pedersen, S. S., Scherders, M., Griez, E., Widdershoven, J., … Appels, A. (2006). Relative lack of depressive cognitions in post-myocardial infarction depression. Journal of Affective Disorders, 94, 231–237.CrossRefGoogle ScholarPubMed
Martens, E. J., Hoen, P. W., Mittelhaeuser, M., de Jonge, P., & Denollet, J. (2010). Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis. Psychological Medicine, 40, 807–814.CrossRefGoogle ScholarPubMed
Meijer, A., Conradi, H. J., Bos, E. H., Thombs, B. D., van Melle, J. P., & de Jonge, P. (2011). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: A meta-analysis of 25 years of research. General Hospital Psychiatry, 33, 203–216.CrossRefGoogle ScholarPubMed
Meijer, A., Zuidersma, M., & de Jonge, P. (2013). Depression as a non-causal variable risk marker in coronary heart disease. BMC Medicine, 11, 130.CrossRefGoogle ScholarPubMed
Moise, N., Khodneva, Y., Jannat-Khah, D. P., Richman, J., Davidson, K. W., Kronish, I. M., … Safford, M. M. (2018). Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: The REGARDS study. BMJ Open, 8, e017385.CrossRefGoogle ScholarPubMed
National Statistics (2015). English indices of deprivation 2015 Ministry of Housing, Communities & Local Government. 30 September 2015.Google Scholar
NHS England (2019). 2019/20 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF) Guidance for GMS contract 2019/20 in England.Google Scholar
Ormel, J., & de Jonge, P. (2011). Unipolar depression and the progression of coronary artery disease: Toward an integrative model. Psychotherapy and Psychosomatics, 80, 264–274.CrossRefGoogle ScholarPubMed
Palacios, J., Khondoker, M., Mann, A., Tylee, A., & Hotopf, M. (2018). Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs. Journal of Psychosomatic Research, 104, 1–8.CrossRefGoogle ScholarPubMed
Palacios, J. E., Khondoker, M., Achilla, E., Tylee, A., & Hotopf, M. (2016). A single, one-off measure of depression and anxiety predicts future symptoms, higher healthcare costs, and lower quality of life in coronary heart disease patients: Analysis from a multi-wave, primary care cohort study. PLoS ONE, 11, e0158163.CrossRefGoogle ScholarPubMed
Pequignot, R., Dufouil, C., Prugger, C., Peres, K., Artero, S., Tzourio, C., & Empana, J. P. (2016). High level of depressive symptoms at repeated study visits and risk of coronary heart disease and stroke over 10 years in older adults: The three-city study. Journal of the American Geriatrics Society, 64, 118–125.CrossRefGoogle ScholarPubMed
Rabin, R., & de Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol group. Annals of Medicine, 33, 337–343.CrossRefGoogle ScholarPubMed
Roest, A. M., Carney, R. M., Freedland, K. E., Martens, E. J., Denollet, J., & de Jonge, P. (2013). Changes in cognitive versus somatic symptoms of depression and event-free survival following acute myocardial infarction in the Enhancing Recovery In Coronary Heart Disease (ENRICHD) study. Journal of Affective Disorders, 149, 335–341.CrossRefGoogle ScholarPubMed
Roest, A. M., Thombs, B. D., Grace, S. L., Stewart, D. E., Abbey, S. E., & de Jonge, P. (2011). Somatic/affective symptoms, but not cognitive/affective symptoms, of depression after acute coronary syndrome are associated with 12-month all-cause mortality. Journal of Affective Disorders, 131, 158–163.CrossRefGoogle Scholar
Rose, G. A. (1962). The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bulletin of the World Health Organization, 27, 645–658.Google Scholar
Scafato, E., Galluzzo, L., Ghirini, S., Gandin, C., Rossi, A., Solfrizzi, V., … Group, I. W. (2012). Changes in severity of depressive symptoms and mortality: The Italian longitudinal study on aging. Psychological Medicine, 42, 2619–2629.CrossRefGoogle ScholarPubMed
Smolderen, K. G., Spertus, J. A., Reid, K. J., Buchanan, D. M., Krumholz, H. M., Denollet, J., … Chan, P. S. (2009). The association of cognitive and somatic depressive symptoms with depression recognition and outcomes after myocardial infarction. Circulation. Cardiovascular Quality and Outcomes, 2, 328–337.CrossRefGoogle ScholarPubMed
Tully, P. J., Winefield, H. R., Baker, R. A., Turnbull, D. A., & de Jonge, P. (2011). Confirmatory factor analysis of the Beck Depression Inventory-II and the association with cardiac morbidity and mortality after coronary revascularization. Journal of Health Psychology, 16, 584–595.CrossRefGoogle ScholarPubMed
Tylee, A., Ashworth, M., Barley, E., Brown, J., Chambers, J., Farmer, A., … Walters, P. (2011). Up-beat UK: A programme of research into the relationship between coronary heart disease and depression in primary care patients. BMC Family Practice, 12, 38.CrossRefGoogle ScholarPubMed
Walters, P., Barley, E. A., Mann, A., Phillips, R., & Tylee, A. (2014). Depression in primary care patients with coronary heart disease: Baseline findings from the UPBEAT UK study. PLoS ONE, 9, e98342.CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed
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