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Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study.

ABSTRACT: To assess the association between time-varying depressive symptoms with all-cause and cause-specific mortality.The REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a national, population-based longitudinal study conducted from 2003 to 2007.General continental US communities.29?491 black and white US adults ?45 years randomly sampled within race-sex-geographical strata.Elevated depressive symptoms (Centre for Epidemiologic Studies Depression (CES-D) 4?4) measured at baseline and on average 5 and 7 years later.Cox proportional hazard regression models assessed cancer, non-cardiovascular (cardiovascular disease (CVD)), CVD and all-cause mortality.The average age was 64.9 years; 55% were women; 41% black; 11.0% had elevated depressive symptoms; 54% had poor, fair or good health. Time-varying depressive symptoms were significantly associated with non-CVD (adjusted HR (aHR)=1.29, 95%?CI 1.16 to 1.44) and all-cause (aHR=1.24, 95%?CI 1.14 to 1.39), but not cancer (aHR=1.15, 95%?CI 0.96 to 1.38) or CVD (aHR=1.13, 95%?CI 0.98 to 1.32) death adjusting for demographics, chronic clinical diseases, behavioural risk factors and physiological factors. Depressive symptoms were related to all-cause (aHR=1.48, 95%?CI 1.27 to 1.78), CVD (aHR=1.37, 95%?CI 0.99 to 1.91), non-CVD (aHR=1.54, 95%?CI 1.24 to 1.92) and cancer (aHR=1.36, 95% CI 0.97 to 1.91) death in those who reported excellent or very good health. The analyses of the association between one measure of baseline depressive symptoms and mortality analyses yielded similar results.Time-varying depressive symptoms confer an increased risk for all-cause mortality, CVD, non-CVD death and cancer death, particularly in those with excellent or very good health. These findings may have implications for timely treatment, regardless of health status.

SUBMITTER: Moise N

PROVIDER: S-EPMC5780736 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study.

Moise Nathalie N Khodneva Yulia Y Jannat-Khah Deanna Pereira DP Richman Joshua J Davidson Karina W KW Kronish Ian M IM Shaffer Jonathan J Safford Monika M MM

BMJ open 20180105 1

<h4>Objective</h4>To assess the association between time-varying depressive symptoms with all-cause and cause-specific mortality.<h4>Design</h4>The REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a national, population-based longitudinal study conducted from 2003 to 2007.<h4>Setting</h4>General continental US communities.<h4>Participants</h4>29 491 black and white US adults ≥45 years randomly sampled within race-sex-geographical strata.<h4>Exposure</h4>Elevated depressive sy ...[more]

PMID: 29306879

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Project description:OBJECTIVE:To describe the relationship between metabolic health parameters and depressive symptoms and perceived stress, and whether the co-occurrence of these two psychological stressors has an additive influence on metabolic dysregulation in adults at different levels of body mass index (BMI) without diabetes. METHODS:Participants without diabetes (N?=?20,312) from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study (recruited between 2003-2007) who had a body mass index (BMI)???18.5?kg/m2 were included in this cross-sectional analysis. Mean age of sample was 64.4 years, with 36% African American, and 56% women. Depressive symptoms and perceived stress were measured using brief versions of the Center for Epidemiologic Studies Depression (CES-D-4 item) questionnaire and Cohen Perceived Stress Scale (PSS), respectively. Metabolic health parameters included waist circumference, blood pressure (systolic and diastolic), low- and high-density lipoprotein (LDL, HDL) cholesterol, triglycerides, fasting glucose, and high sensitivity C-reactive protein (hs-CRP). Sequentially adjusted general linear regression models (GLM) for each metabolic parameter were used to assess the association between having both elevated depressive symptoms and stress, either of these psychological risk factors, or none with all analyses stratified by BMI category (i.e., normal, overweight, and obesity). RESULTS:The presence of elevated depressive symptoms and/or perceived stress was generally associated with increased waist circumference, higher CRP, and lower HDL. The combination of depressive symptoms and perceived stress, compared to either alone, was typically associated with poorer metabolic health outcomes. However, sociodemographic and lifestyle factors generally attenuated the associations between psychological factors and metabolic parameters. CONCLUSIONS:Elevated depressive symptoms in conjunction with high levels of perceived stress were more strongly associated with several parameters of metabolic health than only one of these psychological constructs in a large, diverse cohort of adults. Findings suggest that healthy lifestyle factors may attenuate the association between psychological distress and metabolic health impairment.

Dataset Information

Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study.

Publications

Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study.

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