title: A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study.
abstract: Behavioral factors are important in disease incidence and mortality and may explain associations between mortality and various psychological traits.
  
  
  
  These analyses investigated the impact of behavioral factors on the associations between depression, hostility and cardiovascular disease(CVD) incidence, CVD mortality, and all-cause mortality.
  
  
  
  Data from the PRIME Study (N = 6953 men) were analyzed using Cox proportional hazards models, following adjustment for demographic and biological CVD risk factors, and other psychological traits, including social support.
  
  
  
  Following initial adjustment, both depression and hostility were significantly associated with both mortality outcomes (smallest SHR = 1.24, p < 0.001). Following adjustment for behavioral factors, all relationships were attenuated both when accounting for and not accounting for other psychological variables. Associations with all-cause mortality remained significant (smallest SHR = 1.14, p = 0.04). Of the behaviors included, the most significant contribution to outcomes was found for smoking, but a role was also found for fruit and vegetable intakes and high alcohol consumption.
  
  
  
  These findings demonstrate well-known associations between depression, hostility, and mortality and suggest the potential importance of behaviors in explaining these relationships.
authors.affiliation: Department of Psychology, Bournemouth University, Poole, BH12 5BB, UK. k.appleton@bournemouth.ac.uk.
authors.forename: K M
authors.initials: KM
authors.lastname: Appleton
authors.affiliation: School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK.
authors.forename: J V
authors.initials: JV
authors.lastname: Woodside
authors.affiliation: Department of Epidemiology and Public Health, University of Strasbourg, EA3430, Strasbourg, France.
authors.forename: D
authors.initials: D
authors.lastname: Arveiler
authors.affiliation: Department of Epidemiology and Public Health, University of Strasbourg, EA3430, Strasbourg, France.
authors.forename: B
authors.initials: B
authors.lastname: Haas
authors.affiliation: The Lille Monica Project, INSERM U744, Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Amouyel
authors.affiliation: The Lille Monica Project, INSERM U744, Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Montaye
authors.affiliation: The Toulouse MONICA Project, INSERM UMR1027, Toulouse, France.
authors.forename: J
authors.initials: J
authors.lastname: Ferrieres
authors.affiliation: The Toulouse MONICA Project, INSERM UMR1027, Toulouse, France.
authors.forename: J B
authors.initials: JB
authors.lastname: Ruidavets
authors.affiliation: School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK.
authors.forename: J W G
authors.initials: JW
authors.lastname: Yarnell
authors.affiliation: School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK.
authors.forename: F
authors.initials: F
authors.lastname: Kee
authors.affiliation: School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK.
authors.forename: A
authors.initials: A
authors.lastname: Evans
authors.affiliation: The Coordinating Center, INSERM U780, Hôpital Paul Brousse, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Bingham
authors.affiliation: The Coordinating Center, INSERM U780, Hôpital Paul Brousse, Villejuif, France.
authors.forename: P
authors.initials: P
authors.lastname: Ducimetiere
authors.affiliation: School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BJ, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Patterson
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology* / Q000401:mortality* / Q000523:psychology*; D003863:Depression / Q000150:complications / Q000523:psychology*; D005602:France / Q000453:epidemiology; D006791:Hostility; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009660:Northern Ireland / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors
keywords: Behavior; Cardiovascular disease; Depression; Hostility; Mortality; Social support