Shades of a Blue Heart: An Epidemiological Investigation Of Depressive Symptom Dimensions And The Association With Cardiovascular Disease

Shades of a Blue Heart: An Epidemiological Investigation Of Depressive Symptom Dimensions And The Association With Cardiovascular Disease

This thesis provides an investigation of the association between depression and cardiovascular disease, taking into account the diversity of depressive symptoms. We looked into the effect of these symptoms on medical prognosis (e.g. mortality). We did this by either using information extracted from the medical literature and from international individual patient databases.We demonstrated that somatic/affective symptoms of depression (i.e. fatigue) are stronger predictors of adverse prognosis than cognitive/affective symptoms (e.g. guilt feelings) are. An important issue of studying depressive symptoms in these patients, is that somatic/affective symptoms can be secondary to heart disease (or other disease), and mistakenly be regarded as depressive symptoms. By using complex statistical models, we managed to isolate this confounding effect of somatic symptoms unrelated to depression in our analyses. We concluded that levels of depressive symptoms can be used to predict risk of adverse prognosis, even in the light of this confounding effect.We also found that there is variation in the prognostic value of individual depressive symptoms in men and women with MI across different age groups. For instance, cognitive/affective symptoms seem to be particularly dangerous for younger men, while somatic/affective symptoms seem to be more dangerous for older individuals.

Dissertation: http://hdl.handle.net/11370/c7859598-c653-46f9-9db7-ef371dcc8d83