Professor Annette Dobson
School of Population Health, The University of Queensland
$42,315 (bb) – total funding $84,630
Heart Foundation Strategic Research Partnership
Project completion year
The relationship between cardiovascular disease (CVD) and depression is complex. Depression has been recognised as a common co-morbid condition with CVD and has been associated with poorer outcomes for patients with myocardial infarction, coronary artery bypass surgery and atherosclerosis. A recent review of the evidence underlying the links between a history of depression and the risk of CVD concluded there was strong and consistent evidence that depression is an independent risk factor for heart disease.
Despite the fact that women are more vulnerable to depression than men and that CVD is the leading cause of death of adult women in Australia, relatively little research has focused specifically on the relationship between depression and CVD in women. This project was particularly focused on investigating the relationship between CVD and depression in middle-aged women.
Participants were drawn from the 1946 to 1951 birth cohort of the Australian Longitudinal Study on Women’s Health. In 2004, this group was 53 to 58 years old. The project sent cardiac-focused surveys to women who had reported a diagnosis of heart disease in the 2004 or 2007 surveys, and 306 women returned completed questionnaires.
Among women without any history of CVD, a diagnosis of depression is associated with the subsequent onset of CVD. This association could not be fully explained by socio-demographic factors (age, marital status, area of residence), lifestyle factors (smoking, alcohol, exercise, body mass index, social support) or medical factors (menopausal status, chronic health conditions).
The project also explored the impact of depression and anxiety in a subset of women with angina. Women with co-morbid depression and anxiety are significantly more likely to report symptoms of angina, with increasing symptom severity associated with commensurate reduction in health-related quality of life. An analysis of completed surveys found there is a relationship between the severity of angina symptoms and psychological factors. Compared to women with no depression or anxiety, women with co-morbid depression and anxiety were five times more likely to have mild symptoms of angina and more than 11 times more likely to have severe symptoms of angina.
The odds of having angina in women with anxiety only or depression only were not significantly higher than those without depression or anxiety. Health-related quality of life was increasingly impaired with increasing severity of angina. Lifestyle factors (smoking, alcohol and exercise) and a history of depression or anxiety were not significantly related to increasing angina severity. The lack of a significant relationship between lifestyle factors and worsening angina suggests a direct association between psychological distress and angina.
This study of middle-aged women showed clear evidence that women with poor mental health, especially diagnosed depression, have increased risk of subsequent cardiovascular disease.