The Predictive Value of Depressive Symptoms for All-Cause Mortality: Findings From the PRIME Belfast Study Examining the Role of Inflammation and Cardiovascular Risk Markers. Issue 4 (May 2016)

• Record Type: Journal Article
• Authors: Hughes, Maria F.; Patterson, Christopher C.; Appleton, Katherine M.; Blankenberg, Stefan; Woodside, Jayne V.; Donnelly, Michael; Linden, Gerard; Zeller, Tanja; Esquirol, Yolande; Kee, Frank
• Is Part Of: Psychosomatic medicine. Volume 78:Issue 4(2016)
• Publication Date: 2016-05
• Subjects: depression -- biological markers -- all-cause mortality -- mediators -- BMI = body mass index -- CRP = C-reactive protein -- CT-proET = C-terminal pro–endothelin-1 -- HPA axis = hypothalamic-pituitary-adrenal axis -- HR = hazard ratio -- IL-1Ra = interleukin-1 receptor antagonist -- IL-18 = interleukin-18 -- MR-proADM = midregion pro-adrenomedullin -- MR-proANP = midregion pro–atrial natriuretic peptide -- NT-proBNP = N-terminal pro–b-type natriuretic peptide -- SES = socioeconomic status; Medicine, Psychosomatic -- Periodicals; 616.0805
• DOI: 10.1097/PSY.0000000000000289
• Languages: English
• ISSNs: 0033-3174

Abstract

ABSTRACT: Objectives: To improve understanding about the potential underlying biological mechanisms in the link between depression and all-cause mortality and to investigate the role that inflammatory and other cardiovascular risk factors may play in the relationship between depressive symptoms and mortality. Methods: Depression and blood-based biological markers were assessed in the Belfast PRIME prospective cohort study ( N = 2389 men, aged 50–59 years) in which participants were followed up for 18 years. Depression was measured using the 10-item Welsh Pure Depression Inventory. Inflammation markers (C-reactive protein [CRP], neopterin, interleukin [IL]-1 receptor antagonist [IL-1Ra], and IL-18) and cardiovascular-specific risk factors (N-terminal pro–b-type natriuretic peptide, midregion pro–atrial natriuretic peptide, midregion pro-adrenomedullin, C-terminal pro–endothelin-1 [CT-proET]) were obtained at baseline. We used Cox proportional hazards modeling to examine the association between depression and biological measures in relation to all-cause mortality and explore the mediating effects. Results: During follow-up, 418 participants died. Higher levels of depressive symptoms were associated with higher levels of CRP, IL-1Ra, and CT-proET. After adjustment for socioeconomic and life-style risk factors, depressive symptoms were significantly associated with all-cause mortality (hazard ratio = 1.10 per scale unit, 95% confidence interval = 1.04–1.16). This association was partly explained by CRP (7.3%) suggesting a minimal mediation effect. IL-1Ra, N-terminal pro–b-type natriuretic peptide, midregion pro–atrial natriuretic peptide, midregion pro-adrenomedullin, and CT-proET contributed marginally to the association between depression and subsequent mortality. Conclusions: Inflammatory and cardiovascular risk markers are associated with depression and with increased mortality. However, depression and biological measures show additive effects rather than a pattern of meditation of biological factors in the association between depression and mortality. Abstract : Supplemental digital content is available in the text.