DEPRESSED AFFECT, HOPELESSNESS, AND THE RISK OF ISCHEMIC-HEART-DISEASE IN A COHORT OF UNITED-STATES ADULTS

Major depression has been associated with mortality from ischemic hear t disease (IHD). In addition, a symptom of depression-hopelessness-has been suggested as a determinant of health status. We studied the rela tion of both depressed affect and hopelessness to IHD incidence using data from a cohort of 2,832 U.S. adults age 45-77 years who participat ed in the National Health Examination Follow-up Study (mean follow-up = 12.4 years) and had no history of IHD or serious illness at baseline . We used the depression subscale of the General Well-Being Schedule t o define depressed affect and a single item from the scale to define h opelessness. At baseline, 11.1% of the cohort had depressed affect; 10 .8% reported moderate hopelessness, and 2.9% reported severe hopelessn ess. Depressed affect and hopelessness were more common among women, b lacks and persons who were less educated, unmarried, smokers, or physi cally inactive. There were 189 cases of fatal IHD during the follow-up period. After we adjusted for demographic and risk factors, depressed affect was related to fatal IHD [relative risk = 1.5; 95% confidence interval (CI) = 1.0-2.3]; the relative risks of fatal IHD for moderate and severe levels of hopelessness were 1.6 (95% CI = 1.0-2.5) and 2.1 (95% CI = 1.1-3.9), respectively. Depressed affect and hopelessness w ere also associated with an increased risk of nonfatal IHD. These data indicate that depressed affect and hopelessness may play a causal rol e in the occurrence of both fatal and nonfatal IHD.