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Depressive symptom clusters are differentially associated with atherosclerotic disease

Published online by Cambridge University Press:  10 December 2010

B. A. A. Bus ,
R. M. Marijnissen ,
S. Holewijn ,
B. Franke ,
N. Purandare ,
J. de Graaf ,
M. den Heijer ,
J. K. Buitelaar  and
R. C. Oude Voshaar
B. A. A. Bus*
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
R. M. Marijnissen
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Old Age Psychiatry, De Gelderse Roos, Arnhem, The Netherlands
S. Holewijn
Affiliation:
Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
B. Franke
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
N. Purandare
Affiliation:
Psychiatry Research Group, School of Community-Based Medicine, University of Manchester, Manchester, UK
J. de Graaf
Affiliation:
Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
M. den Heijer
Affiliation:
Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
J. K. Buitelaar
Affiliation:
Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
R. C. Oude Voshaar
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Psychiatry Research Group, School of Community-Based Medicine, University of Manchester, Manchester, UK University Centre of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
*
*Address for correspondence: B. A. A. Bus, M.D., Department of Psychiatry, Radboud University Nijmegen (RUN) Medical Centre, Reinier Postlaan 10, 6525GC Nijmegen, The Netherlands. (Email: [email protected])
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Abstract

Background

Depression increases the risk of subsequent vascular events in both cardiac and non-cardiac patients. Atherosclerosis, the underlying process leading to vascular events, has been associated with depression. This association, however, may be confounded by the somatic-affective symptoms being a consequence of cardiovascular disease. While taking into account the differentiation between somatic-affective and cognitive-affective symptoms of depression, we examined the association between depression and atherosclerosis in a community-based sample.

Method

In 1261 participants of the Nijmegen Biomedical Study (NBS), aged 50–70 years and free of stroke and dementia, we measured the intima–media thickness (IMT) of the carotid artery as a measure of atherosclerosis and we assessed depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis (PCA) of the BDI items yielded two factors, representing a cognitive-affective and a somatic-affective symptom cluster. While correcting for confounders, we used separate multiple regression analyses to test the BDI sum score and both depression symptom clusters.

Results

We found a significant correlation between the BDI sum score and the IMT. Cognitive-affective, but not somatic-affective, symptoms were also associated with the IMT. When we stratified for coronary artery disease (CAD), the somatic-affective symptom cluster correlated significantly with depression in both patients with and patients without CAD.

Conclusions

The association between depressive symptoms and atherosclerosis is explained by the somatic-affective symptom cluster of depression. Subclinical vascular disease thus may inflate depressive symptom scores and may explain why treatment of depression in cardiac patients hardly affects vascular outcome.

Keywords

Agedatherosclerosiscognitive-affectivedepressionelderlyfactor analysisintima–media thickness (IMT)somatic-affective
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 7 , July 2011 , pp. 1419 - 1428
Copyright
Copyright © Cambridge University Press 2010

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