title: Effects of depressive symptoms and coronary heart disease and their interactive associations on mortality in middle-aged adults: the Whitehall II cohort study.
abstract: BACKGROUND
  Depression and mortality have been studied separately in patients with coronary heart disease (CHD) and in populations healthy at study inception. This does not allow comparisons across risk-factor groups based on the cross-classification of depression and CHD status.
  
  
  OBJECTIVE
  To examine effects of depressive symptoms and CHD and their interactive associations on mortality in middle-aged adults followed over 5.6years.
  
  
  METHODS
  A prospective population-based cohort study of 5936 middle-aged men and women from the British Whitehall II study. We created four risk-factor groups based on the cross-classification of depressive symptoms and CHD status.
  
  
  RESULTS
  The age-adjusted and sex-adjusted hazard ratios for death from all causes were 1.67 (p<0.05) for participants with only CHD, 2.10 (p<0.001) for those with only depressive symptoms and 4.99 (p<0.001) for those with both CHD and depressive symptoms when compared to participants without either condition. The two latter risk-factor groups remained at increased risk after adjustments for relevant confounders. The relative excess risk due to the interaction between depressive symptoms and CHD for all-cause mortality was 3.58 (95% CI -0.09 to 7.26), showing some evidence of an additive interaction. A similar pattern was also observed for cardiovascular death.
  
  
  CONCLUSIONS
  This study provides evidence that depressive symptoms are associated with an increased risk of all-cause and cardiovascular death and that this risk is particularly marked in depressive participants with co-morbid CHD.
authors.affiliation: INSERM, U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, France. hermann.nabi@inserm.fr
authors.forename: Hermann
authors.initials: H
authors.lastname: Nabi
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shipley
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Martica
authors.initials: M
authors.lastname: Hall
authors.forename: Jyrki
authors.initials: J
authors.lastname: Korkeila
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
mesh_terms: D000328:Adult; D017677:Age Distribution; D003327:Coronary Disease / Q000209:etiology* / Q000401:mortality; D003863:Depression / Q000150:complications* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012923:Social Class