Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-03T05:43:59.533Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: a meta-analysis

Published online by Cambridge University Press:  27 January 2014

R. de Miranda Azevedo ,
A. M. Roest ,
P. W. Hoen  and
P. de Jonge
R. de Miranda Azevedo*
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
A. M. Roest
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
P. W. Hoen
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
P. de Jonge
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
*
*Address for correspondence: R. de Miranda Azevedo, M.Sc., Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Several prospective longitudinal studies have suggested that somatic/affective depressive symptoms, but not cognitive/affective depressive symptoms, are related to prognosis in patients with heart disease, but findings have been inconsistent. The aim of this study was to investigate the association of cognitive/affective and somatic/affective symptoms of depression with cardiovascular prognosis in patients with heart disease using a meta-analytic perspective.

Method

A systematic search was performed in PubMed, EMBASE and PsycInfo. Thirteen prospective studies on symptom dimensions of depression and cardiovascular prognosis fulfilled the inclusion criteria, providing data on a total of 11 128 subjects. The risk estimates for each dimension of depressive symptoms, demographic and methodological variables were extracted from the included articles.

Results

In least-adjusted analyses, both the somatic/affective [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.19–1.41, p < 0.001] and cognitive/affective (HR 1.07, 95% CI 1.00–1.15, p = 0.05) dimensions of depressive symptoms were associated with cardiovascular prognosis. In fully adjusted analyses, somatic/affective symptoms were significantly associated with adverse prognosis (HR 1.19, 95% CI 1.10–1.29, p < 0.001) but cognitive/affective symptoms were not (HR 1.04, 95% CI 0.97–1.12, p = 0.25). An increase of one standard deviation (±1 s.d.) in the scores of the somatic/affective dimension was associated with a 32% increased risk of adverse outcomes (HR 1.32, 95% CI 1.17–1.48, p < 0.001).

Conclusions

Somatic/affective depressive symptoms were more strongly and consistently associated with mortality and cardiovascular events in patients with heart disease compared with cognitive/affective symptoms. Future research should focus on the mechanisms by which somatic/affective depressive symptoms may affect cardiovascular prognosis.

Keywords

Depressionheart diseasemeta-analysissymptom dimension
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 13 , October 2014 , pp. 2689 - 2703
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barefoot, JC, Brummett, BH, Helms, MJ, Mark, DB, Siegler, IC, Williams, RB (2000). Depressive symptoms and survival of patients with coronary artery disease. Psychosomatic Medicine 6, 790–795.CrossRefGoogle Scholar
Barth, J, Schumacher, M, Herrmann-Lingen, C (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine 6, 802–813.Google Scholar
Baumeister, H, Hutter, N, Bengel, J (2012). Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression. Cochrane Database of Systematic Reviews. Issue 12, Art. No. CD008381.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA (1987). Beck Depression Inventory: Manual. Psychological Corporation: San Antonio, TX.Google Scholar
Bekke-Hansen, S, Trockel, M, Burg, MM, Taylor, CB (2012). Depressive symptom dimensions and cardiac prognosis following myocardial infarction: results from the ENRICHD clinical trial. Psychological Medicine 1, 51–60.Google Scholar
Blumenthal, JA (2008). Depression and coronary heart disease: association and implications for treatment. Cleveland Clinic Journal of Medicine 75 (Suppl. 2), S48–S53.Google Scholar
Blumenthal, JA, Sherwood, A, Babyak, MA, Watkins, LL, Smith, PJ, Hoffman, BM, O'Hayer, CV, Mabe, S, Johnson, J, Doraiswamy, PM, Jiang, W, Schocken, DD, Hinderliter, AL (2012). Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study. Journal of the American College of Cardiology 12, 1053–1063.CrossRefGoogle Scholar
Blumenthal, JA, Sherwood, A, Babyak, MA, Watkins, LL, Waugh, R, Georgiades, A, Bacon, SL, Hayano, J, Coleman, RE, Hinderliter, A (2005). Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial. Journal of the American Medical Association 13, 1626–1634.Google Scholar
Borenstein, M, Hedges, L, Higgins, J, Rothstein, H (2005). Comprehensive Meta-analysis, Version 2. Biostat, Englewood NJ.Google Scholar
Bosch, NM, Riese, H, Dietrich, A, Ormel, J, Verhulst, FC, Oldehinkel, AJ (2009). Preadolescents’ somatic and cognitive-affective depressive symptoms are differentially related to cardiac autonomic function and cortisol: the TRAILS study. Psychosomatic Medicine 9, 944–950.Google Scholar
Brennan, P, Silman, A (1992). Statistical methods for assessing observer variability in clinical measures. British Medical Journal (Clinical Research ed.) 6840, 1491–1494.Google Scholar
Carney, RM, Freedland, KE (2012). Are somatic symptoms of depression better predictors of cardiac events than cognitive symptoms in coronary heart disease? Psychosomatic Medicine 1, 33–38.CrossRefGoogle Scholar
Conger, A (1980). Integration and generalization of kappas for multiple raters. Psychological Bulletin 2, 322–328.Google Scholar
Connerney, I, Sloan, RP, Shapiro, PA, Bagiella, E, Seckman, C (2010). Depression is associated with increased mortality 10 years after coronary artery bypass surgery. Psychosomatic Medicine 9, 874–881.Google Scholar
Davidson, KW, Pickering, TG, Jonas, BS (2001). Cautionary note on the use of pulse pressure as a risk factor for coronary heart disease. Circulation 22, E128–E129.Google Scholar
de Jonge, P, Mangano, D, Whooley, MA (2007). Differential association of cognitive and somatic depressive symptoms with heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. Psychosomatic Medicine 8, 735–739.Google Scholar
de Jonge, P, Ormel, J, van den Brink, RH, van Melle, JP, Spijkerman, TA, Kuijper, A, van Veldhuisen, DJ, van den Berg, MP, Honig, A, Crijns, HJ, Schene, AH (2006). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry 1, 138–144.CrossRefGoogle Scholar
Delisle, VC, Beck, AT, Ziegelstein, RC, Thombs, BD (2012). Symptoms of heart disease or its treatment may increase Beck Depression Inventory Scores in hospitalized post-myocardial infarction patients. Journal of Psychosomatic Research 3, 157–162.Google Scholar
DerSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 3, 177–188.Google Scholar
Frasure-Smith, N, Lesperance, F (2003). Depression and other psychological risks following myocardial infarction. Archives of General Psychiatry 6, 627–636.CrossRefGoogle Scholar
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal (Clinical Research ed.) 7414, 557–560.CrossRefGoogle Scholar
Hoen, PW, Whooley, MA, Martens, EJ, Na, B, van Melle, JP, de Jonge, P (2010). Differential associations between specific depressive symptoms and cardiovascular prognosis in patients with stable coronary heart disease. Journal of the American College of Cardiology 11, 838–844.Google Scholar
Irvine, J, Basinski, A, Baker, B, Jandciu, S, Paquette, M, Cairns, J, Connolly, S, Roberts, R, Gent, M, Dorian, P (1999). Depression and risk of sudden cardiac death after acute myocardial infarction: testing for the confounding effects of fatigue. Psychosomatic Medicine 6, 729–737.CrossRefGoogle Scholar
Kupper, N, Widdershoven, JW, Pedersen, SS (2012). Cognitive/affective and somatic/affective symptom dimensions of depression are associated with current and future inflammation in heart failure patients. Journal of Affective Disorders 3, 567–576.CrossRefGoogle Scholar
Lamers, F, Vogelzangs, N, Merikangas, KR, de Jonge, P, Beekman, AT, Penninx, BW (2013). Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Molecular Psychiatry 18, 692–699.Google Scholar
Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gotzsche, PC, Ioannidis, JP, Clarke, M, Devereaux, PJ, Kleijnen, J, Moher, D (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of Clinical Epidemiology 10, e1–e34.Google Scholar
Light, R (1971). Measures of response agreement for qualitative data: some generalizations and alternatives. Psychological Bulletin 5, 365–377.Google Scholar
Linke, SE, Rutledge, T, Johnson, BD, Vaccarino, V, Bittner, V, Cornell, CE, Eteiba, W, Sheps, DS, Krantz, DS, Parashar, S, Bairey Merz, CN (2009). Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: a report from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation. Archives of General Psychiatry 5, 499–507.Google Scholar
Martens, EJ, Hoen, PW, Mittelhaeuser, M, de Jonge, P, Denollet, J (2010). Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis. Psychological Medicine 5, 807–814.CrossRefGoogle Scholar
Meijer, A, Conradi, HJ, Bos, EH, Anselmino, M, Carney, RM, Denollet, J, Doyle, F, Freedland, KE, Grace, SL, Hosseini, SH, Lane, DA, Pilote, L, Parakh, K, Rafanelli, C, Sato, H, Steeds, RP, Welin, C, de Jonge, P (2013 a). Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. British Journal of Psychiatry 203, 90–102.CrossRefGoogle ScholarPubMed
Meijer, A, Conradi, HJ, Bos, EH, Thombs, BD, van Melle, JP, de Jonge, P (2011). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research. General Hospital Psychiatry 3, 203–216.Google Scholar
Meijer, A, Zuidersma, M, de Jonge, P (2013 b). Depression as a non-causal variable risk marker in coronary heart disease. BMC Medicine 11, 130.Google Scholar
Nicholson, A, Kuper, H, Hemingway, H (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal 23, 2763–2774.Google Scholar
Ormel, J, de Jonge, P (2011). Unipolar depression and the progression of coronary artery disease: toward an integrative model. Psychotherapy and Psychosomatics 5, 264–274.Google Scholar
Riley, RD, Lambert, PC, Abo-Zaid, G (2010). Meta-analysis of individual participant data: rationale, conduct, and reporting. British Medical Journal (Clinical Research ed.) 340, c221.Google Scholar
Roest, AM, Carney, RM, Freedland, KE, Martens, EJ, Denollet, J, de Jonge, P (2013). Changes in cognitive versus somatic symptoms of depression and event-free survival following acute myocardial infarction in the Enhancing Recovery In Coronary Heart Disease (ENRICHD) study. Journal of Affective Disorders 149, 335–341.Google Scholar
Roest, AM, Thombs, BD, Grace, SL, Stewart, DE, Abbey, SE, de Jonge, P (2011). Somatic/affective symptoms, but not cognitive/affective symptoms, of depression after acute coronary syndrome are associated with 12-month all-cause mortality. Journal of Affective Disorders 131, 158–163.CrossRefGoogle Scholar
Schiffer, AA, Pelle, AJ, Smith, OR, Widdershoven, JW, Hendriks, EH, Pedersen, SS (2009). Somatic versus cognitive symptoms of depression as predictors of all-cause mortality and health status in chronic heart failure. Journal of Clinical Psychiatry 12, 1667–1673.Google Scholar
Smolderen, KG, Spertus, JA, Reid, KJ, Buchanan, DM, Krumholz, HM, Denollet, J, Vaccarino, V, Chan, PS (2009). The association of cognitive and somatic depressive symptoms with depression recognition and outcomes after myocardial infarction. Circulation. Cardiovascular Quality and Outcomes 4, 328–337.Google Scholar
Smolderen, KG, Spertus, JA, Reid, KJ, Buchanan, DM, Vaccarino, V, Lichtman, JH, Bekelman, DB, Chan, PS (2012). Association of somatic and cognitive depressive symptoms and biomarkers in acute myocardial infarction: insights from the translational research investigating underlying disparities in acute myocardial infarction patients’ health status registry. Biological Psychiatry 1, 22–29.CrossRefGoogle Scholar
Soeken, KL, Sripusanapan, A (2003). Assessing publication bias in meta-analysis. Nursing Research 1, 57–60.CrossRefGoogle Scholar
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Journal of the American Medical Association 15, 2008–2012.Google Scholar
Thombs, BD, Bass, EB, Ford, DE, Stewart, KJ, Tsilidis, KK, Patel, U, Fauerbach, JA, Bush, DE, Ziegelstein, RC (2006). Prevalence of depression in survivors of acute myocardial infarction. Journal of General Internal Medicine 1, 30–38.Google Scholar
Thombs, BD, Ziegelstein, RC, Pilote, L, Dozois, DJ, Beck, AT, Dobson, KS, Fuss, S, de Jonge, P, Grace, SL, Stewart, DE, Ormel, J, Abbey, SE (2010). Somatic symptom overlap in Beck Depression Inventory-II scores following myocardial infarction. British Journal of Psychiatry 1, 61–66.Google Scholar
Tully, PJ, Winefield, HR, Baker, RA, Turnbull, DA, de Jonge, P (2011). Confirmatory factor analysis of the Beck Depression Inventory-II and the association with cardiac morbidity and mortality after coronary revascularization. Journal of Health Psychology 4, 584–595.Google Scholar
van den Broek, KC, Tekle, FB, Habibovic, M, Alings, M, van der Voort, PH, Denollet, J (2013). Emotional distress, positive affect, and mortality in patients with an implantable cardioverter defibrillator. International Journal of Cardiology 165, 327–332.Google Scholar
van Melle, JP, de Jonge, P, Spijkerman, TA, Tijssen, JG, Ormel, J, van Veldhuisen, DJ, van den Brink, RH, van den Berg, MP (2004). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosomatic Medicine 6, 814–822.Google Scholar
Ziegelstein, RC, Fauerbach, JA, Stevens, SS, Romanelli, J, Richter, DP, Bush, DE (2000). Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Archives of Internal Medicine 12, 1818–1823.Google Scholar
Supplementary material: Image

de Miranda Azevedo Supplementary Material

Figure S1

Download de Miranda Azevedo Supplementary Material(Image)
Image 8.3 MB
Supplementary material: File

de Miranda Azevedo Supplementary Material

Supplementary Material

Download de Miranda Azevedo Supplementary Material(File)
File 22.5 KB