Category Archive for: ‘Depression’
High optimism low CVD mortality
Optimism was a relatively stable trait over 15 years in the Zutphen Elderly Study. Elderly men with a high level of optimism had only half the risk of 15-year CVD mortality compared to those with a low level of optimism. Similar results were obtained after adjustment for CVD risk factors, lifestyle factors, living arrangements, self-rated health and depressive symptoms.
Optimism was not related to major cardiovascular risk factors. However, a high level of optimism was associated with better coping behavior, goal-directed efforts such as better self-care, vitality, emotional flexibility and seeking social support. Optimism was also related to physical activity, non-smoking, moderate alcohol intake and higher intakes of fruit, vegetables and whole-grain bread. This suggests that a high level of optimism affects the risk of cardiovascular death through positive psycho-social behaviors, more healthy lifestyle and dietary habits.
Depressive symptoms related to CVD mortality
Elderly men from the FINE study cohorts of Finland, the Netherlands and Italy who manifested a number of depressive symptoms had a 2-fold greater 10-year CVD mortality. The relative risk did not change after excluding cases that died from CVD in the first 5 years of follow-up. The strongest associations were observed with the mortality from stroke and heart failure and the relation with CHD mortality was of borderline statistical significance. Depressive symptoms were not related to risk of other degenerative heart diseases and no differences in risk from depression were observed between northern and southern Europe.
The results of this study provide strong support for the hypothesis that depressive symptoms are a real and causal risk factor for CVD. Its prospective design, established that the depressive symptoms preceded the fatal CVD event. Furthermore, the large sample size and the long follow-up made it possible to exclude subjects who died from CVD in the first five years after baseline, making reversed causality unlikely, that is, that the event caused the depressive symptoms. Adjustment for many confounding variables made it likely that the depressive symptoms had an independent effect.
Disability and depressive symptoms related to all-cause mortality
Self-rated health, disability and depressive symptoms were independent from each other, and were associated with all-cause mortality in elderly men from Finland, The Netherlands and Italy (the FINE study). After adjustment for the prevalence of chronic diseases severity of disability and depressive symptoms remained related to all-cause mortality.
Combinations of measures also associated with all-cause mortality
For the combination of disability and self-rated health a 3-fold greater mortality risk was observed for men who had severe disability and a poor self-rated health compared to the reference group. Men with severe disability in the two highest categories of depressive symptoms had also a 3-fold higher mortality risk.
These results suggest that for adequate prognosis of mortality and for developing intervention strategies information is needed on other and different health outcomes.
Disability associated with depressive symptoms
An increasing severity of disability from entry to 5 year follow-up was positively associated with depressive symptoms. Men with no disability scored lower on depressive symptoms than those with disability in any of three domains (see below). The associations were stronger in Finland and Italy than in the Netherlands.
Among men with mild disability, whose disability status worsened over 5 years, scored higher on depressive symptoms than those whose status improved.
In elderly men from Finland, Italy and the Nethelands, self-reported information on disability and depressive symptoms was collected on 2 surveys, in 1990 and 1995. Three domains of disability were distinguished: instrumental, mobility-related and basic activities using the WHO questionnaire on Activities of Daily Living.
A healthy lifestyle and diet associated with a higher level of optimism
Moderate physical activity, refraining from smoking and moderate alcohol consumption were associated with an high level of optimism.
Eating more fruit, vegetables, and whole grain bread was also related to a higher level of optimism.
Optimistic through healthy living?
Optimism was associated with a lower risk of cardiovascular death, but the underlying mechanisms for this association are unknown. Therefore, the associations of diet and lifestyle with optimism were investigated in the Zutphen Elderly Study. Information on lifestyle, diet and optimism was collected every 5 years in the period 1985-2000.
Optimism associated with a lower risk of depression
In the Zutphen Elderly Study a high level of optimism in 1985 was associated with a 77% lower risk of depressive symptoms in either 1990, 1995 or 2000. Men free of depressive symptoms in 1990 had a 63% lower cumulative 10-year incidence of depressive symptoms. These results suggest that optimistic elderly men are at a lower risk to develop depressive symptoms.
Measuring optimism and depression
Dispositional optimism was assessed with a 4-item questionnaire of the Central Bureau of Statistics in The Netherlands and depressive symptoms with the 20-items validated Zung self-rating depression scale.
Omega-3 fatty acids associated with lower risk of depressive symptoms
A cross-sectional analysis of the Zutphen Elderly Study showed that men with an average daily intake of the fish fatty acids EPA-DHA (407 mg per day), followed for 10 years, had a 54% lower risk of depressive symptoms compared to those with an average daily intake of 21 mg/d. An explanation for this association might be that low levels of EPA-DHA are associated with low levels of neurotransmitters and with markers of inflammation and endothelial dysfunction.
B-vitamins not related to depressive symptoms
Major depression is associated with with lower blood levels of B-vitamins. The B-vitamins folate, vitamin B6 and B12 are involved in the production of neurotransmitters and low levels are associated with depression. However, in a cross-sectional analysis the intake of B-vitamins was not related to depressive symptoms in the Zutphen Elderly Study.
Depression and physical inactivity, two sides of the same coin?
The relationship between depressive symptoms and CVD risk may be the consequence of a more sedentary lifestyle of depressed persons. Thus, physical inactivity may be the intermediate factor in the relation between depressive symptoms and CVD. The independent and combined effects of depressive symptoms and physical activity on CVD mortality were investigated prospectively in elderly men from the FINE study cohorts of Finland, the Netherlands and Italy.
Physical inactivity and depression both related to cardiovascular risk.
A 30 min/d lower level of physical activity at entry was associated with a 9% excess CVD mortality after 10 years. A one-standard deviation greater score for depressive symptoms was related to a 37% higher CVD mortality, after adjustment for physical activity. The excess risk of CVD mortality attributable to the combined effect of depressive symptoms with inactivity was 47%. The greater risk of CVD due to depressive symptoms cannot be explained by physical inactivity. However, depressive symptoms and physical inactivity may interact to increase CVD risk.
Moderate physical activity inversely associated with depression
At least mild physical activities (2 kcal/kg/hour, so f.i. for a 70 kg person that would be 140 kcal/hour) were inversely related to depressive symptoms in the baseline survey of the Finland, Italy, Netherlands Elderly study. One unit of moderate physical activity (30 min per day of walking, cycling, gardening and sports) at baseline was associated with a 3% lower risk of depressive symptoms 5 years later.
Moderate alcohol intake inversely related to depression but not to smoking
Moderate alcohol intake (less than 31 gram per day, equal to 3 glasses/d) entry was related to a 65% lower risk of depressive symptoms 5 years later, but the prevalence of smoking did not predict depressive symptoms.
- Kamphuis et al. Med Sci Sports Exerc 2007;39:1693-9
- Bots et al. Int J Geriatr Psychiatry 2008;23:478-84
Poor lung function associated with depression
Data from the Finnish and Italian cohorts showed that poor lung function in men aged 50-69 was associated with subsequent depressive symptoms 15-30 years later. This association was stronger in men with chronic diseases than in those without.
Decline in serum cholesterol predictor of depression
Among elderly men from Finland, The Netherlands and Italy, a 5-year decline in total serum cholesterol level was a predictor of depressive symptoms 5 years later. Men with two or more cardiovascular risk factors at entry (obesity, smoking, hypertension, hypercholesterolaemia, or diabetes) had no higher future risk of depression in the Zutphen Elderly Study.
- Giltay et al Am J Geriatr Psychiatry 2008;16:874-82
- Bots et al. Int J Geriatr Psychiatry 2008;23:478-84
- Giltay et al. Psychosomatic Med 2010;72:53-60