title: Depressive symptom clusters are differentially associated with atherosclerotic disease.
abstract: BACKGROUND
  Depression increases the risk of subsequent vascular events in both cardiac and non-cardiac patients. Atherosclerosis, the underlying process leading to vascular events, has been associated with depression. This association, however, may be confounded by the somatic-affective symptoms being a consequence of cardiovascular disease. While taking into account the differentiation between somatic-affective and cognitive-affective symptoms of depression, we examined the association between depression and atherosclerosis in a community-based sample.
  
  
  METHODS
  In 1261 participants of the Nijmegen Biomedical Study (NBS), aged 50-70 years and free of stroke and dementia, we measured the intima-media thickness (IMT) of the carotid artery as a measure of atherosclerosis and we assessed depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis (PCA) of the BDI items yielded two factors, representing a cognitive-affective and a somatic-affective symptom cluster. While correcting for confounders, we used separate multiple regression analyses to test the BDI sum score and both depression symptom clusters.
  
  
  RESULTS
  We found a significant correlation between the BDI sum score and the IMT. Cognitive-affective, but not somatic-affective, symptoms were also associated with the IMT. When we stratified for coronary artery disease (CAD), the somatic-affective symptom cluster correlated significantly with depression in both patients with and patients without CAD.
  
  
  CONCLUSIONS
  The association between depressive symptoms and atherosclerosis is explained by the somatic-affective symptom cluster of depression. Subclinical vascular disease thus may inflate depressive symptom scores and may explain why treatment of depression in cardiac patients hardly affects vascular outcome.
authors.affiliation: Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. b.bus@psy.umcn.nl
authors.forename: B A A
authors.initials: BA
authors.lastname: Bus
authors.forename: R M
authors.initials: RM
authors.lastname: Marijnissen
authors.forename: S
authors.initials: S
authors.lastname: Holewijn
authors.forename: B
authors.initials: B
authors.lastname: Franke
authors.forename: N
authors.initials: N
authors.lastname: Purandare
authors.forename: J
authors.initials: J
authors.lastname: de Graaf
authors.forename: M
authors.initials: M
authors.lastname: den Heijer
authors.forename: J K
authors.initials: JK
authors.lastname: Buitelaar
authors.forename: R C Oude
authors.initials: RC
authors.lastname: Voshaar
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications* / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D025341:Principal Component Analysis / Q000379:methods; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data