Temporal Relation among Depression Symptoms, Cardiovascular Disease Events, and Mortality in End-Stage Renal Disease
Open Access
- 1 May 2006
- journal article
- Published by Wolters Kluwer Health in Clinical Journal of the American Society of Nephrology
- Vol. 1 (3), 496-504
- https://doi.org/10.2215/cjn.00030505
Abstract
Temporal relationships among depression, medical comorbidity, and death or cardiovascular disease (CVD) events are complex. Clarifying temporal relationships may enhance current insight regarding the nature of the association of depression with poor outcomes. The temporal relation of depression symptoms (DS; score ≤52 on five-item Mental Health Index) assessed at 6-mo intervals for 2 yr to CVD event, all-cause death, cardiovascular disease deaths, and non–cardiovascular disease deaths was studied in 917 incident dialysis patients. Cox regression models were used to assess whether the proximity of DS measurement and DS duration would change observed associations between DS and events. Whether increasing medical comorbidity was associated with worsening DS also was assessed. In time-varying models, DS were strongly associated with all-cause deaths, cardiovascular disease deaths, and CVD events (adjusted relative hazard [95% confidence interval]: 2.22 [1.36 to 3.60], 3.27 [1.57 to 6.81], and 1.68 [1.05 to 2.69], respectively). Persistent and current DS were associated with greater risks for all-cause death. Incorporating a 6-mo time lag between DS and outcomes attenuated risks for all-cause death, non–cardiovascular disease deaths, and CVD events. In a subgroup analysis, patients with worsening medical comorbidity (n = 32) during the first year of follow-up experienced a 2.42-point greater decline in mental health scores at 2 yr of follow-up compared with patients with no worsening in medical comorbidity (n = 123), but findings were not statistically significant. DS are strongly related to death and CVD events, with persistent/current DS most strongly associated with poor outcomes. Attenuated risks from time-lag analyses indicate a partial role for reverse causality, suggesting that medical comorbidity may precede DS.Keywords
This publication has 54 references indexed in Scilit:
- Low Heart Rate Variability and the Effect of Depression on Post–Myocardial Infarction MortalityArchives of Internal Medicine, 2005
- High Lipoprotein(a) Levels and Small Apolipoprotein(a) Size Prospectively Predict Cardiovascular Events in Dialysis PatientsJournal of the American Society of Nephrology, 2005
- Predictors of Depression Three Months After Cardiac HospitalizationPsychosomatic Medicine, 2004
- Small Apolipoprotein(a) Size Predicts Mortality in End-Stage Renal DiseaseCirculation, 2002
- Disability under Social Security for patients with ESRD: an evidence-based reviewDisability and Rehabilitation, 2001
- The MOS 36-ltem Short-Form Health Survey (SF-36)Medical Care, 1992
- Psychosocial Predictors of Survival in End-Stage Renal DiseaseJournal of Nervous & Mental Disease, 1990
- The Robust Inference for the Cox Proportional Hazards ModelJournal of the American Statistical Association, 1989
- Consistent Covariance Matrix Estimation with Cross-Sectional Dependence and Heteroskedasticity in Financial DataJournal of Financial and Quantitative Analysis, 1989