title: Hopelessness, depressive symptoms, and carotid atherosclerosis in women: the Study of Women's Health Across the Nation (SWAN) heart study.
abstract: OBJECTIVE
  Depression and hopelessness are associated with increased cardiovascular disease (CVD) morbidity and mortality; however, few studies have compared these constructs early in the atherogenic process, particularly in women or minorities.
  
  
  METHODS
  This cross-sectional study examined associations of hopelessness and depressive symptoms with carotid artery intimal-medial thickening (IMT) in 559 women (62% white, 38% black; mean+/-SD age, 50.2+/-2.8 years) without evidence of clinical CVD from the Study of Women's Health Across the Nation (SWAN) Heart Study. Hopelessness was measured by 2 questionnaire items; depressive symptoms were measured with the 20-item Center for Epidemiological Studies Depression Scale. Mean and maximum IMT were assessed by B-mode ultrasonography of the carotid arteries.
  
  
  RESULTS
  Increasing hopelessness was significantly related to higher mean (P=0.0139) and maximum (P=0.0297) IMT in regression models adjusted for age, race, site, income, and CVD risk factors. A weaker pattern of associations was noted for depressive symptoms and mean (P=0.1056) and maximum (P=0.0691) IMT. Modeled simultaneously in a risk factor-adjusted model, hopelessness was related to greater mean IMT (P=0.0217) and maximum IMT (P=0.0409), but depressive symptoms were unrelated to either outcome (P>0.4). No interactions with race or synergistic effects of depressive symptoms and hopelessness were observed.
  
  
  CONCLUSIONS
  Among middle-aged women, higher levels of hopelessness are associated with greater subclinical atherosclerosis independent of age, race, income, CVD risk factors, and depressive symptoms.
authors.affiliation: Luther College, Decorah, Iowa, USA.
authors.forename: Mary O
authors.initials: MO
authors.lastname: Whipple
authors.forename: Tené T
authors.initials: TT
authors.lastname: Lewis
authors.forename: Kim
authors.initials: K
authors.lastname: Sutton-Tyrrell
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.forename: Emma
authors.initials: E
authors.lastname: Barinas-Mitchell
authors.forename: Lynda H
authors.initials: LH
authors.lastname: Powell
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
mesh_terms: D001741:Black or African American; D017677:Age Distribution; D000367:Age Factors; D000375:Aging / Q000523:psychology; D000886:Anthropometry; D002339:Carotid Arteries / Q000473:pathology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011237:Predictive Value of Tests; D044469:Racial Groups; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D017539:Tunica Intima; D018616:Ultrasonography, Doppler, Duplex; D044465:White People