title: Association of subsyndromal and depressive symptoms with inflammatory markers among different ethnic groups: the multi-ethnic study of atherosclerosis (MESA).
abstract: OBJECTIVE
  Depressive symptoms are associated with inflammation yet the association between inflammation and different levels of depression remains unclear. Therefore, we studied the association of subsyndromal and depressive symptoms with inflammatory markers in a large multi-ethnic cohort.
  
  
  METHODS
  C-reactive protein (CRP) (n=6269), interleukin-6 (IL-6) (n=6135) and tumor necrosis factor-alpha (TNF-α) (n=1830) were measured in selected participants from the multi-ethnic study of atherosclerosis (MESA). Subsyndromal depressive symptoms were defined as a CES-D value from 8 to 15, depressive symptoms as a CES-D≥16 and normal as a CES-D≤7. Depressive states (subsyndromal and depressed) were entered into multivariable linear regression models incrementally adjusting for demographic, behavioral, biologic and comorbidities.
  
  
  RESULTS
  Among 6289 participants not taking antidepressants and free from CVD, the mean age was 62.2, while 52% were women, 36.4% were Caucasian, 28.9% African-American, 22.3% Hispanics and 12.4% Chinese-American. Of the total, 24.2% had subsyndromal depression and 11.8% had depressive symptoms. Compared to the non-depressed group and after controlling for demographics, there was no association between both subsyndromal and depressive symptoms with logCRP (β=-0.01, p=0.80 and β=-0.05, p=0.25 respectively), logIL-6 (β=0.01, p=0.71 and β=-0.04, p=0.07 respectively) and logTNF-α (β=-0.03, p=0.29 and β=0.06, p=0.18 respectively). Moreover, fully adjusted models showed no significant associations for logIL-6 and logTNF-α and the different depressive categories. However, with full adjustment, we found a significant inverse association between depressive symptoms and lnCRP (β=-0.10, p=0.01) that was not present for subsyndromal depression (β=-0.05, p=0.11).
  
  
  CONCLUSIONS
  Among participants not taking anti-depressants, subsyndromal depression is not associated with inflammation. However, depressive symptoms measured by CES-D≥16 are associated with a lower inflammation (CRP).
authors.affiliation: Department of Family & Preventive Medicine, University of California, San Diego, USA. Electronic address: acamacho@ucsd.edu.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Camacho
authors.affiliation: Department of Family & Preventive Medicine, University of California, San Diego, USA.
authors.forename: Britta
authors.initials: B
authors.lastname: Larsen
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: Department of Family & Preventive Medicine, University of California, San Diego, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Department of Family & Preventive Medicine, University of California, San Diego, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.affiliation: Department of Medicine, University of Vermont, Burlington, VT, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: Department of Family & Preventive Medicine, University of California, San Diego, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
mesh_terms: D001741:Black or African American; D000368:Aged; D001213:Asian; D050197:Atherosclerosis / Q000097:blood* / Q000208:ethnology / Q000523:psychology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003863:Depression / Q000097:blood* / Q000208:ethnology / Q000523:psychology; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D044465:White People
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein
keywords: Cardiovascular disease; Depressive states; Inflammation; Subsyndromal depression