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Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: a meta-analysis

Published online by Cambridge University Press:  27 January 2014

R. de Miranda Azevedo ,
A. M. Roest ,
P. W. Hoen  and
P. de Jonge
R. de Miranda Azevedo*
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
A. M. Roest
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
P. W. Hoen
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
P. de Jonge
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
*
*Address for correspondence: R. de Miranda Azevedo, M.Sc., Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. (Email: [email protected])
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Abstract

Background

Several prospective longitudinal studies have suggested that somatic/affective depressive symptoms, but not cognitive/affective depressive symptoms, are related to prognosis in patients with heart disease, but findings have been inconsistent. The aim of this study was to investigate the association of cognitive/affective and somatic/affective symptoms of depression with cardiovascular prognosis in patients with heart disease using a meta-analytic perspective.

Method

A systematic search was performed in PubMed, EMBASE and PsycInfo. Thirteen prospective studies on symptom dimensions of depression and cardiovascular prognosis fulfilled the inclusion criteria, providing data on a total of 11 128 subjects. The risk estimates for each dimension of depressive symptoms, demographic and methodological variables were extracted from the included articles.

Results

In least-adjusted analyses, both the somatic/affective [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.19–1.41, p < 0.001] and cognitive/affective (HR 1.07, 95% CI 1.00–1.15, p = 0.05) dimensions of depressive symptoms were associated with cardiovascular prognosis. In fully adjusted analyses, somatic/affective symptoms were significantly associated with adverse prognosis (HR 1.19, 95% CI 1.10–1.29, p < 0.001) but cognitive/affective symptoms were not (HR 1.04, 95% CI 0.97–1.12, p = 0.25). An increase of one standard deviation (±1 s.d.) in the scores of the somatic/affective dimension was associated with a 32% increased risk of adverse outcomes (HR 1.32, 95% CI 1.17–1.48, p < 0.001).

Conclusions

Somatic/affective depressive symptoms were more strongly and consistently associated with mortality and cardiovascular events in patients with heart disease compared with cognitive/affective symptoms. Future research should focus on the mechanisms by which somatic/affective depressive symptoms may affect cardiovascular prognosis.

Keywords

Depressionheart diseasemeta-analysissymptom dimension
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 13 , October 2014 , pp. 2689 - 2703
Copyright
Copyright © Cambridge University Press 2014 

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