title: Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low- and High-Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study.
abstract: Psychosocial risk for cardiovascular disease (CVD) may be especially deleterious in persons with low socioeconomic status. Most work has focused on psychosocial factors individually, but emerging research suggests that the confluence of psychosocial risk may be particularly harmful. Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, we examined associations among depressive symptoms and stress, alone and in combination, and incident CVD and all-cause mortality as a function of socioeconomic status.
  
  
  
  At baseline, 22 658 participants without a history of CVD (58.8% female, 41.7% black, mean age 63.9±9.3 years) reported on depressive symptoms, stress, annual household income, and education. Participants were classified into 1 of 3 psychosocial risk groups at baseline: (1) neither depressive symptoms nor stress, (2) either depressive symptoms or stress, or (3) both depressive symptoms and stress. Cox proportional hazards models were used to predict physician-adjudicated incident total CVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and all-cause mortality over a median of 7.0 years (interquartile range 5.4-8.3 years) of follow-up. In fully adjusted models, participants with both depressive symptoms and stress had the greatest elevation in risk of developing total CVD (hazard ratio 1.48, 95% CI 1.21-1.81) and all-cause mortality (hazard ratio 1.33, 95% CI 1.13-1.56) but only for those with low income (<$35 000) and not high (≥$35 000) income. This pattern of results was not observed in models stratified by education.
  
  
  
  Findings suggest that screening for a combination of elevated depressive symptoms and stress in low-income persons may help identify those at increased risk of incident CVD and mortality.
authors: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA js4456@cumc.columbia.edu.
authors: Jennifer A
authors: JA
authors: Sumner
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL.
authors: Yulia
authors: Y
authors: Khodneva
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL.
authors: Paul
authors: P
authors: Muntner
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL.
authors: Nicole
authors: N
authors: Redmond
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL.
authors: Marquita W
authors: MW
authors: Lewis
authors: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY.
authors: Karina W
authors: KW
authors: Davidson
authors: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY.
authors: Donald
authors: D
authors: Edmondson
authors: Department of Surgery, School of Medicine, University of Alabama at Birmingham, AL.
authors: Joshua
authors: J
authors: Richman
authors: Department of Medicine, Weill Cornell Medical College, New York, NY.
authors: Monika M
authors: MM
authors: Safford
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology*; D011203:Poverty / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data
keywords: cardiovascular diseases; depression; mortality; socioeconomic status; stress