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Original Article
Nov 2011

Depression and History of Attempted Suicide as Risk Factors for Heart Disease Mortality in Young Individuals

Author Affiliations

Author Affiliations: Division of Cardiology, Department of Medicine (Drs Shah, Veledar, and Vaccarino), Department of Psychiatry and Behavioral Sciences (Dr Bremner), and Department of Epidemiology, Rollins School of Public Health (Dr Vaccarino), Emory University, and Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (Dr Hong), Atlanta, Georgia.

Arch Gen Psychiatry. 2011;68(11):1135-1142. doi:10.1001/archgenpsychiatry.2011.125

Context Although depression is associated with increased cardiovascular morbidity and mortality, there is virtually no information on whether it also increases the risk in young populations.

Objectives We sought to determine the association of unipolar and bipolar depression and a history of attempted suicide with mortality due to ischemic heart disease (IHD) and cardiovascular disease (CVD) in young US adults and to examine potential sex differences.

Design Longitudinal epidemiologic study.

Setting Nationally representative sample of US adults.

Participants A total of 7641 US adults aged 17 to 39 years from the 1988-1994 Third National Health and Nutrition Examination Survey.

Main Outcome Measures Cardiovascular disease and IHD mortality. Unipolar/bipolar depression and a history of attempted suicide were assessed via the Diagnostic Interview Schedule.

Results After a median follow-up of 14.9 years, a total of 51 subjects (0.67%) died of CVD causes and 28 (0.37%) died of IHD. Depression (538 individuals [7.04%]) and history of attempted suicide (419 [5.48%]) were each associated with an increased risk of IHD death, with adjusted hazard ratios of 3.70 (95% CI, 1.32-10.35) for depression and 7.12 (2.67-18.98) for a history of attempted suicide. Women with depression or a history of attempted suicide had a 3-fold adjusted risk of CVD (adjusted hazard ratio, 3.20 [95% CI, 1.12-9.17]) and a 14-fold adjusted risk of IHD (14.57 [2.65-80.10]). Corresponding figures for men were 2.37 (0.85-6.58) and 3.52 (1.05-11.76).

Conclusion In adults younger than 40 years, depression and history of attempted suicide are significant independent predictors of premature CVD and IHD mortality in both sexes.