title: The association of depressive symptoms with cardiovascular and all-cause mortality in Central and Eastern Europe: Prospective results of the HAPIEE study.
abstract: Studies in western populations have shown a positive association between depression and cardiovascular disease (CVD) and all-cause mortality. The association with depressive symptoms seems to be graded, rather than limited to the presence versus the absence of depression. Evidence from populations with potentially different patterns of confounders helps to address the consistency of these findings. The objective of the study was to investigate the association between depressive symptoms and all-cause and CVD mortality in populations of Central and Eastern Europe.
  
  
  
  This was a prospective cohort study.
  
  
  
  A total of 24,542 participants aged 45-69 years, randomly selected from populations of Novosibirsk (Russia), Krakow (Poland) and six Czech towns, were included. Depressive symptoms, assessed by the 20-item Center for Epidemiologic Studies Depression (CES-D) scale, were used as both continuous and categorical variables. Data on deaths were obtained from local or national death registers. Associations between depression and mortality were assessed using Cox proportional hazards models.
  
  
  
  Over a median of 7 years, 2091 deaths from all causes and 850 CVD deaths occurred in the cohorts. There was a graded association between CES-D score and mortality; the hazard ratio (HR) of CVD mortality for a 1 SD increase in CES-D was 1.20 (95% confidence interval (CI): 1.16-1.24) in men and 1.23 (95% CI: 1.12-1.35) in women; for all-cause mortality, the HRs were 1.13 (95% CI: 1.09-1.18) and 1.17 (95% CI: 1.10-1.25), respectively. The results were similar across countries.
  
  
  
  Depressive symptoms predicted CVD and all-cause mortality independently of a wide range of potential confounders. The association followed a gradient and increased mortality risks were associated with scores below the cut-offs that are commonly used to define 'depression'.
authors.affiliation: Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland mmkozela@gmail.com.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kozela
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.affiliation: Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Besala
authors.affiliation: Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Micek
authors.affiliation: National Institute of Public Health, Prague, Czech Republic.
authors.forename: Ruzena
authors.initials: R
authors.lastname: Kubinova
authors.affiliation: Institute of Internal and Preventive Medicine, Novosibirsk, Russia.|Novosibirsk State Medical University, Novosibirsk, Russia.
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.affiliation: Institute of Internal and Preventive Medicine, Novosibirsk, Russia.
authors.forename: Diana
authors.initials: D
authors.lastname: Denisova
authors.affiliation: MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Richards
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Hynek
authors.initials: H
authors.lastname: Pikhart
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Peasey
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Marmot
authors.affiliation: Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pająk
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D003866:Depressive Disorder / Q000150:complications* / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Depressive symptoms; Eastern Europe; cardiovascular disease; mortality