Persistence of depressive symptoms and cardiovascular death among patientswith affective disorder

Objective: Studies of both community and clinical samples have associated d epressive symptoms with risks for subsequent cardiovascular morbidity and m ortality. Because the physiological mechanisms thought to underlie this lin k would be cumulative in their effects, the following analyses tested the p rediction that risks for cardiovascular death would increase in proportion to the persistence of depressive symptoms in a long-term follow-up. Methods : Baseline assessment was performed as patients sought treatment for major depressive disorder, mania, or schizoaffective disorder. Follow-up evaluati ons occurred semiannually for the next 5 years and annually thereafter. The 903 patients described, observed for a mean of 11.0 years (SD 5.2 years), were divided into thirds according to the proportion of follow-up weeks in episodes of major depressive disorder, schizoaffective disorder, or intermi ttent depressive disorder. The resulting groups were then compared by cumul ative risks of cardiovascular death. Results: Patients whose depressive sym ptoms were the most persistent were no more likely to die of cardiovascular causes than were those with the fewest weeks ill. A regression analysis sh owed that older age and the presence of cardiovascular disease at baseline, but not the subsequent chronicity of depressive symptoms, predicted cardio vascular death. Conclusions: The physiological concomitants of depressive i llness apparently do not promote cardiovascular mortality in a cumulative m anner. Efforts should be directed toward identification of risk factors com mon to both lifetime depressive symptoms and cardiovascular morbidity.