The natural course of elevated levels of depressive symptoms in patients with vascular disease over eight years of follow-up. The SMART-Medea study.
Patients with cardiovascular disease have an increased risk for depression, and depression predicts poor prognosis in these patients, but the long-term course of depression is not known. We studied the natural course of elevated levels of depressive symptoms in patients with cardiovascular disease over eight years follow-up.



Within the Second Manifestations of ARTerial disease - Memory, depression and aging (SMART-Medea) study, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) in 690 patients (62±10 years) at baseline and bi-annually during 8 years follow-up. Natural course was described for symptom severity and course type (never, single episode, intermittent, and chronic) based on the cut-off point of ≥6 on the PHQ-9. Using multinomial regression analysis (reference: never depressed) we estimated age- and sex-adjusted odds ratios (OR) for the associations of demographic factors and vascular disease categories with course type.



Of the 690 patients, 60% was never depressed, 10% had a single episode, 19% had an intermittent and 11% a chronic course of depression. Increased risk for chronic course was observed for women (OR=3.42; 95% CI=1.98-5.90), those with younger age (OR=3.20; 95% CI=1.73-5.94), and for patients with cerebrovascular disease when compared to patients with coronary artery disease (OR=2.50; 95% CI=1.31-4.78).



No information was available on clinical diagnosed major depressive disorder and/or clinical events during follow-up.



In patients with cardiovascular disease, an intermittent or chronic course of elevated levels of depressive symptoms is very common. Patients with cardiovascular disease may require more careful clinical monitoring and management of depressive symptoms.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands(c)Listed in acknowledgments.
Minke
M
Kooistra
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Yolanda
Y
van der Graaf
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Anne M
AM
Grool
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Nicolaas P A
NP
Zuithoff
Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands(c)Listed in acknowledgments.
Geert
G
Jan Biessels
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. Electronic address: m.geerlings@umcutrecht.nl.
Mirjam I
MI
Geerlings
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000523:psychology*; D002908:Chronic Disease; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
Cohort; Depression; Epidemiology; PHQ-9; Vascular disease