August 17, 2012 — Depression in young adulthood can have lingering effects, including an increased risk for premature death due to cardiovascular disease and injury, a new study shows.
Investigators at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, found that young adult men with depression were nearly twice as likely to have died from any cause compared with those without depression.
Further, roughly one half of deaths among young adult women with depression were due to cardiovascular disease compared with about 13% of their counterparts without depression.
“The expectation that depression has a wide influence on mortality should be clear,” the investigators, led by Lisa Wyman, PhD, MPH, write. “Young adults with depressed mood appear to be particularly vulnerable,” they add.
Ties between depression and increased risk for premature death is “becoming established,” the authors note. A 2002 metaanalysis of 25 community studies placed the overall relative risk estimate at 1.81 (95% confidence interval [CI], 1.58 – 2.07) (Cuijpers et al, J Affect Disord 2002;72:227-236).
“A consistent finding in previous literature has been the association between depression and the development and progression of cardiovascular disease in otherwise-healthy individuals…. The association between depression and the development of cancer is less established…. Findings are mixed, but potential associations with fatal injuries beyond the association with suicide may exist,” the authors write.
Yet, most studies of depression and mortality have focused on older adults; whether depression in young adulthood is linked to specific causes of death throughout life “remains underexplored,” they add.
To investigate, the researchers reviewed data from the Community Mental Health Epidemiology Study (CMHE), a cross-sectional survey that gathered information on the mental health of residents of Washington County, Maryland, in the early 1970s.
Among 2762 respondents, 467 (16.9%) had depressed mood at baseline, defined as a Center for Epidemiologic Studies Depression scale score of 16 or greater. Participants with depressed mood at baseline were mainly women and were younger than participants without depressed mood.
The prevalence of depressed mood decreased with age; only 12.5% of participants aged 65 years and older had elevated symptoms compared with 21.0% of young adults (18 to 39 years) and 15.1% of middle-aged adults (40 to 64 years).
During the 40-year follow-up period, 1547 respondents (56%) died.
Cardiovascular Death in Women
Overall, young adult men (18 to 39 years) with depressed mood at baseline were nearly twice as likely to have died from any cause by the end of follow-up as their nondepressed peers (36.2% vs 18.8%; P < .001). Young adult women with depressed mood did not have significantly greater total mortality than their nondepressed counterparts (16.8% vs 11.9%; P = .12).
According to the researchers, the 18- to 39-year-olds with depressed mood at baseline had a 3-fold increased risk of dying from a cardiovascular cause (hazard ratio [HR], 3.08; 95% CI, 1.74 – 5.45) and a greater than 4-fold increased risk of suffering a fatal injury (HR, 4.63; 95% CI, 1.76 – 12.18) during the entire 40-year period.
Death from injury, including motor vehicle accidents, homicide, and suicide, was more common in young adult men with depressed mood at baseline. The authors note, however, that there was no excess of the suicide deaths in depressed adults, a finding that supports previous work. Most of the suicides in their study occurred in nondepressed adults.
The association between depression and excess cardiovascular death has also been seen previously, the authors write. In the study, 50.0% of deaths among young adult women with depressed mood at baseline were cardiovascular-related vs 13.6% of deaths in women without depressed mood.
Recent data from the National Health and Nutrition Examination Survey III (NHANES III) have also suggested that young adult women with depression may be at excess risk for premature cardiovascular-related death.
“Results from this current study augment these findings by indicating this excess risk may extend into late adulthood for females experiencing depression as young adults,” Dr. Wyman and colleagues write.
There were no significant associations between depressed mood and cancer deaths, a finding that is also consistent with many previous studies.
Overall, findings to date suggest that the effects of depression in early life have a lasting impact on physical health, Dr. Wyman and colleagues conclude.
The study was supported by the National Heart, Lung, and Blood Institute. Additional funding was provided by the Department of Epidemiology Doctoral Thesis Research Fund and the George W. Comstock Center for Public Health Research and Prevention. The authors have disclosed no relevant financial relationships.
Published online July 26, 2012. Abstract
Authors and Disclosures
Megan Brooks is a freelance writer for Medscape.Disclosure: Megan Brooks has disclosed no relevant financial relationships.