Relationship between depression and cerebrovascular disease: conceptual issues

Objectives: The association between cerebrovascular disease (CVD) and depre ssion has been well described, but our understanding of various aspects of the relationship between these two disorders remains Limited. Method: Based on a selective literature review, this paper examines empirical evidence a nd discusses conceptual issues concerning hierarchical, interactive, and co -morbid relationships between CVD and depression. Results: The concept of v ascular depression minimizes the importance of the contribution of psychoso cial factors. The interactive and co-morbid relationships have been largely neglected in psychiatric research. There is evidence that depression may i ncrease the risk of CVD morbidity in patients with vascular disease and del ay recovery in stroke patients, implying an interactive relationship. The c oncurrent existence of these two disorders based on common etiological fact ors such as genetic vulnerability, alcoholism and personality traits seems plausible. Conclusions: A modified comorbidity model may guide investigatio n into the hierarchical, interactive and common etiological relationships b etween CVD and depression. (C) 2000 Elsevier Science B.V. All rights reserv ed.