Mental health and physical wellbeing are strongly interconnected. Specifically, depression is associated with increased cardiovascular morbidity and mortality, as well as an increased incidence of overweight, obesity, and type 2 diabetes. However, these links are mostly defined in older populations. For one of the first times, a new epidemiological study, published in the November issue of Archives of General Psychiatry, examines the risk of heart disease and depression in a younger age group.

The study evaluated a nationally-representative sample of nearly 8000 American adults, aged 17 to 39 years, who participated in the Third Health and Nutrition Examination Survey (NHANES III). The researchers linked the data to the National Death Index. The Diagnostic Interview Schedule assessed each participant’s history of depression and attempted suicide. At the beginning of the study, most of the participants were very healthy.

Over a follow-up period of almost 15 years, 51 participants died of cardiovascular disease (CVD), and 28 of the deaths were due to ischemic heart disease (IHD). In total, 538 participants had a history of depression, 419 reported suicide attempts, and 136 reported both.

After adjusting for multiple health and lifestyle factors, the risk of death from CVD was more than 2 times higher for people with depression than those without and more than 3 times higher for people with past suicide attempts than those with no reported attempts.  The risk of death from IHD was nearly 4 times higher for people with depression, and more than 7 times higher for people with past suicide attempts.

When the researchers divided the group by gender, women with a history of depression had a 3-fold increased risk of death from CVD and a 14-fold increased risk of death from IHD. Correspondingly, men with a history of depression had 2- and 3-fold increased risks of death from CVD and IHD, respectively. However, these results were not statistically significant, likely due to the small number of events that occurred in the entire population.

The authors concluded that depression and a history of suicide attempts are significant independent predictors of heart disease mortality in young adults. This underscores previous research that suggests psychological health foretells vulnerability to heart disease. The authors suggest that clinicians must be more mindful of assessing mental health and cardiovascular health in routine practice, even among younger populations.

The findings of the study are limited by the relatively small number of events that occurred during the study period. And, the conclusions are not based on age, so mortality data may be skewed by older participants.

Still, the fact remains that depression and other mental health disorders can indicate an increased risk for heart disease. While depression is common among young adults, screening for cardiovascular health is not. Enhanced monitoring for and prevention of cardiovascular risk factors following a diagnosis of depression may be warranted, even in young populations.

References

Ludescher B, Machann J, Eschweiler GW, Thamer C, Maenz C, Hipp A, Claussen CD, & Schick F (2011). Active depression is associated with regional adiposity in the upper abdomen and the neck. International journal of psychiatry in medicine, 41 (3), 271-80 PMID: 22073766

Rubin RR, Gaussoin SA, Peyrot M, DiLillo V, Miller K, Wadden TA, West DS, Wing RR, Knowler WC, & Look AHEAD Research Group (2010). Cardiovascular disease risk factors, depression symptoms and antidepressant medicine use in the Look AHEAD (Action for Health in Diabetes) clinical trial of weight loss in diabetes. Diabetologia, 53 (8), 1581-9 PMID: 20422396

Rutledge T, Linke SE, Krantz DS, Johnson BD, Bittner V, Eastwood JA, Eteiba W, Pepine CJ, Vaccarino V, Francis J, Vido DA, & Merz CN (2009). Comorbid depression and anxiety symptoms as predictors of cardiovascular events: results from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. Psychosomatic medicine, 71 (9), 958-64 PMID: 19834049

Shah AJ, Veledar E, Hong Y, Bremner JD, & Vaccarino V (2011). Depression and history of attempted suicide as risk factors for heart disease mortality in young individuals. Archives of general psychiatry, 68 (11), 1135-42 PMID: 22065529

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