title: Directionality of the relationship between depressive symptom dimensions and C-reactive protein in patients with acute coronary syndromes.
abstract: OBJECTIVE
  Previous theoretical models predict that elevated inflammation may predict later depressive symptoms, but bidirectional associations are possible. We examined whether depressive symptoms or inflammation predicts change in the other for a 3-month period in a sample of adults with acute coronary syndromes (ACS).
  
  
  METHODS
  During hospitalization for their index ACS event (baseline) and then again 1 and 3 months later, 163 post-ACS patients completed the Beck Depression Inventory, a measure of depressive symptom severity with cognitive-affective and somatic-affective subscales. C-reactive protein (CRP) was also assessed at each visit; known correlates of depression and CRP were assessed at baseline. Path analyses were conducted to evaluate prospective associations between depressive symptoms and log-transformed CRP values and whether strength and/or directionality varied by specific depressive symptom dimensions.
  
  
  RESULTS
  Baseline total depressive symptom severity predicted a smaller decrease in CRP from baseline to 1 month (unstandardized parameter estimates [B] = 0.04, p < .001) controlling for all covariates, as did baseline cognitive-affective depressive symptom severity (B = 0.10, p = .02). Baseline somatic-affective depressive symptom severity did not predict change in CRP (B = -0.002, p = .94). CRP did not predict 1- or 3-month change in total, cognitive-affective, or somatic-affective depressive symptom severity. The results did not differ for men and women.
  
  
  CONCLUSIONS
  Greater cognitive-affective and total depressive symptom severity at the time of a cardiac event predicts a smaller decrease in CRP 1 month later, but there was no evidence in this study that CRP predicts change in depressive symptoms.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY, USA. js3742@columbia.edu
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
authors.forename: William F
authors.initials: WF
authors.lastname: Chaplin
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
authors.forename: Nina
authors.initials: N
authors.lastname: Rieckmann
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000378:metabolism* / Q000523:psychology; D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism*; D003863:Depression / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D005260:Female; D015438:Health Behavior; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D002097:C-Reactive Protein