Ruiwei Meng1, Canqing Yu2, Na Liu1, Meian He1, Jun Lv2, Yu Guo3, Zheng Bian3, Ling Yang4, Yiping Chen4, Xiaomin Zhang1, Zhengming Chen4, Tangchun Wu1, An Pan1, Liming Li2,3. 1. Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 2. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China. 3. Chinese Academy of Medical Sciences, Beijing, China. 4. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Abstract
Importance: Depression is associated with increased disease burden worldwide and with higher risk of mortality in Western populations. Objective: To investigate whether depression is a risk factor for all-cause and cardiovascular disease (CVD) mortality in adults in China. Design, Setting, and Participants: This cohort study prospectively followed adults aged 30 to 79 years in the China Kadoorie Biobank (CKB) study from June 1, 2004, to December 31, 2016, and adults aged 32 to 104 years in the Dongfeng-Tongji (DFTJ) study from September 1, 2008, to December 31, 2016. Data analysis was conducted from June 1, 2018, to March 31, 2019. Main Outcomes and Measures: Depression was evaluated using the Chinese version of the World Health Organization Composite International Diagnostic Interview-Short Form in the CKB cohort and a 7-item symptoms questionnaire modified from the Composite International Diagnostic Interview-Short Form in the DFTJ cohort. Multivariable-adjusted Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for the association of depression with mortality. Covariates in the final models included sociodemographic characteristics, lifestyle factors, and personal and family medical history. Results: Among 512 712 individuals (mean [SD] age, 52.0 [10.7] years; 302 509 [59.0%] women) in the CKB cohort, there were 44 065 deaths, including 18 273 CVD deaths. The 12-month prevalence of major depressive episode in the CKB cohort was 0.64%, and the 1-month prevalence of clinically significant depressive symptoms was 17.96% in the DFTJ cohort. Among 26 298 individuals (mean [SD] age, 63.6 [7.8] years; 14 508 [55.2%] women) in the DFTJ cohort, there were 2571 deaths, including 1013 CVD deaths. In the multivariable-adjusted model, depression was associated with increased risk of all-cause mortality (CKB cohort: HR, 1.32 [95% CI, 1.20-1.46]; P < .001; DFTJ cohort: HR, 1.17 [95% CI, 1.06-1.29]; P = .002) and CVD mortality (CKB cohort: HR, 1.22 [95% CI, 1.04-1.44]; P = .02; DFTJ cohort: HR, 1.32 [95% CI, 1.14-1.54]; P < .001). In both cohorts, men had statistically significantly higher risk of all-cause mortality (CKB cohort: HR, 1.53 [95% CI, 1.32-1.76]; DFTJ cohort: HR, 1.24 [95% CI, 1.10-1.41]) and CVD mortality (CKB cohort: HR, 1.39 [95% CI, 1.10-1.76]; DFTJ cohort: HR, 1.49 [95% CI, 1.23-1.80]), while the association of depression with mortality among women was only significant for all-cause mortality in the CKB cohort (HR, 1.19 [95% CI, 1.03-1.37]). Conclusions and Relevance: These findings suggest that depression is associated with an increased risk of all-cause and CVD mortality in adults in China, particularly in men. These findings highlight the importance and urgency of depression management as a measure for preventing premature deaths in China.
Importance: Depression is associated with increased disease burden worldwide and with higher risk of mortality in Western populations. Objective: To investigate whether depression is a risk factor for all-cause and cardiovascular disease (CVD) mortality in adults in China. Design, Setting, and Participants: This cohort study prospectively followed adults aged 30 to 79 years in the China Kadoorie Biobank (CKB) study from June 1, 2004, to December 31, 2016, and adults aged 32 to 104 years in the Dongfeng-Tongji (DFTJ) study from September 1, 2008, to December 31, 2016. Data analysis was conducted from June 1, 2018, to March 31, 2019. Main Outcomes and Measures: Depression was evaluated using the Chinese version of the World Health Organization Composite International Diagnostic Interview-Short Form in the CKB cohort and a 7-item symptoms questionnaire modified from the Composite International Diagnostic Interview-Short Form in the DFTJ cohort. Multivariable-adjusted Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for the association of depression with mortality. Covariates in the final models included sociodemographic characteristics, lifestyle factors, and personal and family medical history. Results: Among 512 712 individuals (mean [SD] age, 52.0 [10.7] years; 302 509 [59.0%] women) in the CKB cohort, there were 44 065 deaths, including 18 273 CVD deaths. The 12-month prevalence of major depressive episode in the CKB cohort was 0.64%, and the 1-month prevalence of clinically significant depressive symptoms was 17.96% in the DFTJ cohort. Among 26 298 individuals (mean [SD] age, 63.6 [7.8] years; 14 508 [55.2%] women) in the DFTJ cohort, there were 2571 deaths, including 1013 CVD deaths. In the multivariable-adjusted model, depression was associated with increased risk of all-cause mortality (CKB cohort: HR, 1.32 [95% CI, 1.20-1.46]; P < .001; DFTJ cohort: HR, 1.17 [95% CI, 1.06-1.29]; P = .002) and CVD mortality (CKB cohort: HR, 1.22 [95% CI, 1.04-1.44]; P = .02; DFTJ cohort: HR, 1.32 [95% CI, 1.14-1.54]; P < .001). In both cohorts, men had statistically significantly higher risk of all-cause mortality (CKB cohort: HR, 1.53 [95% CI, 1.32-1.76]; DFTJ cohort: HR, 1.24 [95% CI, 1.10-1.41]) and CVD mortality (CKB cohort: HR, 1.39 [95% CI, 1.10-1.76]; DFTJ cohort: HR, 1.49 [95% CI, 1.23-1.80]), while the association of depression with mortality among women was only significant for all-cause mortality in the CKB cohort (HR, 1.19 [95% CI, 1.03-1.37]). Conclusions and Relevance: These findings suggest that depression is associated with an increased risk of all-cause and CVD mortality in adults in China, particularly in men. These findings highlight the importance and urgency of depression management as a measure for preventing premature deaths in China.
Authors: Christoph U Correll; Marco Solmi; Nicola Veronese; Beatrice Bortolato; Stella Rosson; Paolo Santonastaso; Nita Thapa-Chhetri; Michele Fornaro; Davide Gallicchio; Enrico Collantoni; Giorgio Pigato; Angela Favaro; Francesco Monaco; Cristiano Kohler; Davy Vancampfort; Philip B Ward; Fiona Gaughran; André F Carvalho; Brendon Stubbs Journal: World Psychiatry Date: 2017-06 Impact factor: 49.548
Authors: Cheryl D Bushnell; Seemant Chaturvedi; Kathy R Gage; Paco S Herson; Patricia D Hurn; Monik C Jiménez; Steven J Kittner; Tracy E Madsen; Louise D McCullough; Mollie McDermott; Mathew J Reeves; Tatjana Rundek Journal: J Cereb Blood Flow Metab Date: 2018-08-17 Impact factor: 6.200
Authors: Wenjie Sun; C Mary Schooling; Wai Man Chan; Kin Sang Ho; Tai Hing Lam Journal: J Gerontol A Biol Sci Med Sci Date: 2010-11-24 Impact factor: 6.053
Authors: Jana Wrase; Sabine Klein; Sabine M Gruesser; Derik Hermann; Herta Flor; Karl Mann; Dieter F Braus; Andreas Heinz Journal: Neurosci Lett Date: 2003-09-04 Impact factor: 3.046
Authors: Ronald C Kessler; Patricia Berglund; Olga Demler; Robert Jin; Doreen Koretz; Kathleen R Merikangas; A John Rush; Ellen E Walters; Philip S Wang Journal: JAMA Date: 2003-06-18 Impact factor: 56.272
Authors: Kathrin Koch; Katharina Pauly; Thilo Kellermann; Nina Y Seiferth; Martina Reske; Volker Backes; Tony Stöcker; N Jon Shah; Katrin Amunts; Tilo Kircher; Frank Schneider; Ute Habel Journal: Neuropsychologia Date: 2007-04-19 Impact factor: 3.139