The Association between Depression and Self-Reported CardiovascularDisease among Individuals with Systemic Lupus Erythematous Open Access

Abstract

Background: The association between cardiovascular disease (CVD) and depression has been thoroughly examined through numerous studies. However, few studies have examined this association in populations that suffer from autoimmune disorders, who are at higher risk for developing both CVD and depression. This study seeks to address this gap in knowledge by examining the association between CVD and depression in a population based sample of individuals who have confirmed systemic lupus erythematous diagnoses.

Methods: Data for this study was obtained from 630 participants of the Georgians Organized Against Lupus cohort. Depressive symptoms were measured using the PHQ-9. In addition, we calculated a PHQ-6 score subtracting the scores from the somatic items of the PHQ-9. CVD was defined as self-reported diagnosis by a physician of either myocardial infarction, stroke, coronary heart disease. Multivariate analyses were run to estimate the measure of association among the entire cohort using the PHQ-9 and the PHQ-6. We ran similar analyses stratified by race and gender. Finally, a somatic subscale was calculated from the three items removed from the PHQ-9. Correlations between the somatic scale and lupus disease activity, employment status, and CVD status were assessed.

Results: Of the 630 participants, 221 (35.1%) had depressive symptoms, while 409 (64.9%) did not have depressive symptoms using the standard PHQ-9 cutoff score of 10. After adjusting for age, race and education, depressive symptoms were significantly associated with CVD (Odds Ratio (OR): 1.52, 95% CI: 1.01, 2.28). A similar result was discovered when restricting to women in the sample (OR: 1.64, 95% CI 1.08, 2.50). When using the PHQ-6, the fully adjusted model showed a significant protective association among women (OR: 0.49, 95% CI: 0.25, 0.98).

Conclusion: When measuring depressive symptoms, including the somatic items of the PHQ-9 yielded a positive and statistically significant association between depressive symptoms and CVD when adjusting for age, sex, and education level. When using the PHQ-6, the association was no longer seen among the entire cohort and depression appeared to have a protective effect among the women in the study sample.

Table of Contents

Background and Literature Review .....................................................................................1

Systemic Lupus Erythematous ...........................................................................................1

Association between Depression and Cardiovascular Disease ...............................................1

Plausible Mechanisms ......................................................................................................3

Depression and Cardiovascular Disease in Cohorts with Auto-Immune Diseases ...................3

Manuscript ......................................................................................................................5

Abstract ..........................................................................................................................5

Introduction ....................................................................................................................6 Methods...........................................................................................................................7

Study Sample ...................................................................................................................7

Cardiovascular Disease Measure ........................................................................................8

Depressive Symptoms Measure .........................................................................................8

Covariates .......................................................................................................................9

Statistical Analysis ..........................................................................................................10

Results ...........................................................................................................................11

Sample Characteristics ....................................................................................................11

Associations between Depressive Symptoms and CVD ........................................................12

Somatic Subscale ............................................................................................................13

Discussion ......................................................................................................................13

Tables ............................................................................................................................17

References ......................................................................................................................21

Summary, Public Health Implications, Future Studies ........................................................25

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Systemic Lupus Erythematous Cardiovascular Disease Depression
Committee Chair / Thesis Advisor	Lewis, Tene T, Emory University

Last modified

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	The Association between Depression and Self-Reported CardiovascularDisease among Individuals with Systemic Lupus Erythematous ()	2018-08-28 11:31:20 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions