Symptoms of depression and cardiovascular reactions to acute psychological stress: Evidence from a population study
Introduction
Depression has been linked prospectively to mortality in general and death from cardiovascular disease in particular (for reviews, see Hemingway and Marmot, 1999, Wulsin et al., 1999). However, the mechanisms underlying this association have yet to be established. Candidate mediators or confounders include: socio-economic position; ill-health and disability; unhealthy behaviours, such as smoking; and generally poorer self-care (Wulsin et al., 1999). At a physiological level, increased platelet aggregation (Mikuni et al., 1992) and exaggerated cardiovascular reactions to psychological stress exposure (Kibler and Ma, 2004) have been implicated. It is the latter which is the focus of the current analyses.
Depression has been associated with a variety of physiological adaptations that suggest altered autonomic function. For example, enhancement of cardiac sympathetic activity relative to vagal tone has been reported in those with depression and subclinical depressive symptoms (Carney et al., 1988, Light et al., 1998), as have increased plasma noradrenalin concentrations in patients with major depression (Rudorfer et al., 1985). Thus, the hypothesis that such autonomic dysregulation in depression may also be manifest as exaggerated cardiovascular reactivity which in turn increases the risk of cardiovascular pathology is intuitively appealing. First, exaggerated cardiovascular reactions to acute psychological challenge have long been considered a risk factor for cardiovascular pathology (Lovallo and Gerin, 2003, Schwartz et al., 2004) and several prospective studies have now shown consistently that high reactivity confers a modest additional risk for a range of cardiovascular outcomes, such as high blood pressure, carotid atherosclerosis, carotid intima-thickness, and increased left ventricular mass (e.g. Allen et al., 1997, Barnett et al., 1997, Carroll et al., 2003, Kamarck et al., 1997, Lynch et al., 1998, Markovitz et al., 1998, Trieber et al., 2003). Second, there would appear to be at least some provisional evidence that symptoms of depression may be associated with heightened reactivity. A meta-analysis of 11 relevant studies found small to moderate effect sizes indicative of a positive relationship between depressive symptomatology and cardiovascular reactions to acute psychological stress (Kibler and Ma, 2004). Unfortunately, none of the aggregate effects were statistically significant at conventional levels. Previous studies generally tested fairly small samples and were often conducted on patients with established cardiovascular disease. Further, few of these studies adjusted for potential confounding variables such as demographic factors and medication status.
This underscores the need to examine the association between depressive symptomatology and cardiovascular stress reactivity in a large representative sample. The present study, then, re-visited this association in a substantial and demographically diverse sample of participants. In addition, statistical adjustment for a range of possible confounders was possible. It was hypothesized that symptoms of depression would be positively correlated with the magnitude of cardiovascular reactions to stress.
Section snippets
Participants
Participants were all from Glasgow and the surrounding areas in Scotland. As part of the West of Scotland Twenty-07 Study, they have been followed up at regular intervals since the baseline survey in 1987 (Ford et al., 1994). The full sample size at entry to the study was 3036. The data reported here are from the third follow-up when cardiovascular reactions to an acute psychological challenge were measured (Carroll et al., 2000, Carroll et al., 2003). Reactivity data were available for 1647
Socio-demographics and depression
The mean depression score for the sample as a whole was 3.65 (S.D. = 2.86); the analogous summary statistic for anxiety was 7.19 (S.D. = 3.81). ANOVA yielded main effects for all three independent variables: the older two cohorts recorded higher depression scores than the youngest cohort, F(2, 1591) = 14.61, p < .001, η2 = .018; women displayed higher scores than men, F(1, 1591) = 7.63, p = .006, η2 = .005; those from manual occupational households had higher scores than those from non-manual households, F(1,
Discussion
The mean HADS depression and anxiety scores for participants in the present study are broadly similar to those reported by others in large non-clinical adult samples (Crawford et al., 2001). Depression scores were higher in women, participants from manual occupational households, and those in the middle and oldest cohorts. Variations in depression and depressive symptomatology with sex (e.g. Maier et al., 1999, Pinninelli and Wilkinson, 2002, Weissman et al., 1997) and socio-economic status
Acknowledgements
The West of Scotland Twenty-07 Study is funded by the UK Medical Research Council and the data were originally collected by the MRC Social and Public Health Sciences Unit. We are grateful to all of the participants in the Study, and to the survey staff and research nurses who carried it out. The data are employed here with the permission of the Twenty-07 Steering Group (Project No. EC0503). Kate Hunt and Geoff Der are also funded by the MRC.
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