title: Room for depressed and exhausted mood as a risk predictor for all-cause and cardiovascular mortality beyond the contribution of the classical somatic risk factors in men.
abstract: Depressed mood and exhaustion (DEEX) have gained attention as a risk predictor for cardiovascular disease (CVD). Studies to estimate its ranking in prediction models are sparse.
  
  
  
  The study included 3428 men aged 45-74 years who participated in one of three population-based MONICA/KORA Augsburg surveys conducted between 1984 and 1995. Within a follow-up time of 10 years (31,791 person-years), 557 cases of all-cause mortality and 269 fatal CVD events were observed. Adjusted Cox proportional hazards models were used to assess mortality risks for DEEX and five classical cardiovascular risk factors. The predictive ability was evaluated by the area under the receiver-operating characteristic curve, the integrated discrimination improvement statistics and the net classification improvement.
  
  
  
  The (crude) absolute mortality risk for DEEX was 23.1 cases per 1000 person-years for all-cause and 11.2 for CVD mortality. The adjusted hazard ratios of 1.52 for all-cause and 1.52 for CVD mortality (p < 0.01) were higher than those for hypercholesterolemia and obesity, but lower than for hypertension, smoking and diabetes. The improvements in risk prediction from DEEX were comparable to those of hypercholesterolemia and obesity, but substantially lower than those of hypertension, smoking and diabetes. The adjusted population-attributable risk (PAR) for DEEX accounted for about 15% for all-cause and CVD mortality, which gives DEEX a middle ranking amongst the classical risk factors.
  
  
  
  DEEX is a strong predictor of mortality risk, ranking in a medium position amongst classical somatic risk factors.
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: Ladwig@helmholtz-muenchen.de.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Marten-Mittag
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University of Marburg and Gießen, Germany.
authors.forename: Karoline
authors.initials: K
authors.lastname: Lukaschek
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Hamimatunnisa
authors.initials: H
authors.lastname: Johar
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Xioayan
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Joram
authors.initials: J
authors.lastname: Ronel
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
mesh_terms: D000339:Affect; D000368:Aged; D019540:Area Under Curve; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000523:psychology; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D048909:Diabetes Complications / Q000209:etiology; D005858:Germany; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D005222:Mental Fatigue / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects
keywords: Depressed mood; Predictive ability; Somatic risk factors; Vital exhaustion