title: Incidence and Prognostic Significance of Depressive Symptoms in Peripheral Artery Disease.
abstract: BACKGROUND
  We compared the incidence of depression, defined by a Geriatric Depression Score (GDS) ≥6, between people with versus without peripheral artery disease (PAD). We determined whether depressive symptoms were associated with increased mortality in people with and without PAD.
  
  
  RESULTS
  Nine hundred and fifty-one PAD patients and 478 non-PAD patients were recruited from Chicago medical centers and followed prospectively. At baseline and annually, participants completed the GDS (0-15 scale, score ≥6=depression) and 6-minute walk. Cause of death was confirmed with death certificates. The prevalence of a GDS ≥6 at baseline was 186/951 (19.6%) among PAD versus 63/478 (13.2%) among non-PAD participants (P=0.003). During a mean follow-up of 2.7±1.2 years, 122/712 (17.1%) of participants with PAD versus 51/403 (12.7%) without PAD developed a GDS ≥6 (P=0.047). Adjusting for age, sex, race, comorbidities, and other confounders, PAD participants had an increased rate of developing a GDS ≥6 compared to non-PAD participants (hazard ratio=1.54 (95% CI=1.05-2.25, P=0.026). This association was not statistically significant after adjusting for 6-minute walk (P=0.258). Among PAD participants, a baseline GDS ≥6 was associated with increased all-cause mortality, adjusting for confounders (hazard ratio=1.57, 95% CI=1.12-2.21, P=0.009). This association was not significant after adjusting for 6-minute walk (P=0.224).
  
  
  CONCLUSIONS
  People with PAD have a higher incidence of depressive symptoms than people without PAD. In PAD, depressive symptoms are associated with increased all-cause and cardiovascular mortality. These associations are explained in part by poorer 6-minute walk among people with PAD and among depressed people with PAD, respectively.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL mdm608@northwestern.edu.
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.affiliation: Department of Health Research and Policy, Stanford University, Stanford, CA.
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL Jesse Brown Veterans Affairs Medical Center, Chicago, IL.
authors.forename: Melina R
authors.initials: MR
authors.lastname: Kibbe
authors.affiliation: National Institute on Aging, Bethesda, MD.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Lihui
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Yihua
authors.initials: Y
authors.lastname: Liao
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Ying
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D016022:Case-Control Studies; D002423:Cause of Death; D002641:Chicago / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: atherosclerosis; cardiovascular disease; peripheral vascular disease