Depressive Symptom Clusters Differentially Predict Cardiovascular Hospitalization in People With Type 2 Diabetes.
BACKGROUND
Depression has been associated with the development of cardiovascular disease in people with type 2 diabetes.


OBJECTIVE
We examined whether symptoms related to the 2 core features of depression--dysphoria and anhedonia--and anxiety were differentially associated with cardiovascular hospitalization and whether there were symptom-specific mechanisms (alcohol, smoking, physical activity, body mass index, glucose, cholesterol, and blood pressure) in play.


METHODS
A total of 1465 people in Dutch primary care completed the Edinburgh Depression Scale in 2005 and were followed up until first cardiovascular hospitalization during follow-up (event) or December 31, 2010 (study end). Cox regression analyses examined (1) differences in time to hospitalization for a cardiovascular event between people with a low vs a high baseline dysphoria/anhedonia/anxiety score (adjusting for demographic and clinical confounders) and (2) mediating mechanisms.


RESULTS
A total of 191 people were hospitalized for a cardiovascular event. In univariable analysis, dysphoria predicted a shorter time to cardiovascular hospitalization (hazard ratio = 1.49, 95% CI: 1.02-2.17). After adjustment for confounders, neither dysphoria (hazard ratio = 1.55, 95% CI: 0.91-2.64) nor anhedonia (hazard ratio = 0.83, 95% CI: 0.47-1.48) was significantly associated with time to cardiovascular hospitalization. Anxiety was associated with a longer time to cardiovascular hospitalization (adjusted hazard ratio = 0.49, 95% CI: 0.27-0.89). However, none of the selected factors qualified as a mediator for the (adjusted) association between anxiety and time to cardiovascular hospitalization.


CONCLUSIONS
Dysphoria was associated with a shorter time to cardiovascular hospitalization in unadjusted analyses only, whereas anxiety predicted later hospitalization after confounder adjustment. Anhedonia did not show a significant association. Mechanistic pathways remain unclear.
Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands. Electronic address: g.m.nefs@tilburguniversity.edu.
Giesje
G
Nefs
Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands.
Victor Jozef Marie
VJ
Pop
Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands.
Johan
J
Denollet
Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands.
François
F
Pouwer
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors