Depression as a predictor for coronary heart disease. a review and meta-analysis.
OBJECTIVE
To review and quantify the impact of depression on the development of coronary heart disease (CHD) in initially healthy subjects.


METHODS
Cohort studies on depression and CHD were searched in MEDLINE (1966-2000) and PSYCHINFO (1887-2000), bibliographies, expert consultation, and personal reference files.


METHODS
Cohort studies with clinical depression or depressive mood as the exposure, and myocardial infarction or coronary death as the outcome.


METHODS
Information on study design, sample size and characteristics, assessment of depression, outcome, number of cases, crude and most-adjusted relative risks, and variables used in multivariate adjustments were abstracted.


RESULTS
Eleven studies met the inclusion criteria. The overall relative risk [RR] for the development of CHD in depressed subjects was 1.64 (95% confidence interval [CI]=1.29-2.08, p<0.001). A sensitivity analysis showed that clinical depression (RR=2.69, 95% CI=1.63-4.43, p<0.001) was a stronger predictor than depressive mood (RR=1.49, 95% CI=1.16-1.92, p=0.02).


CONCLUSIONS
It is concluded that depression predicts the development of CHD in initially healthy people. The stronger effect size for clinical depression compared to depressive mood points out that there might be a dose-response relationship between depression and CHD. Implications of the findings for a broader bio-psycho-social framework are discussed.
Rugulies
Reiner
R
Division of Occupational and Environmental Medicine, University of California, San Francisco, USA. rugulies@uclink4.berkeley.edu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000209:etiology*; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity