Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 8
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Cui, Ruifeng Tate, Susan R. Cummins, Kevin Skidmore, Jessica R. and Brown, Sandra A. 2015. Chronic Physical Health Problems Moderate Changes in Depression and Substance Use Among Dual Diagnosed Individuals During and After Treatment. Substance Use & Misuse, Vol. 50, Issue. 2, p. 174.

    Beutel, M. E. Wiltink, J. Kirschner, Y. Sinning, C. Espinola-Klein, C. Wild, P. S. Münzel, T. Blettner, M. Zwiener, I. Lackner, K. and Michal, M. 2014. History of depression but not current depression is associated with signs of atherosclerosis: data from the Gutenberg Health Study. Psychological Medicine, Vol. 44, Issue. 05, p. 919.

    Liang, Yajun Yan, Zhongrui Cai, Chuanzhu Jiang, Hui Song, Aiqin and Qiu, Chengxuan 2014. Association Between Lipid Profile and Depressive Symptoms Among Chinese Older People: Mediation by Cardiovascular Diseases?. International Journal of Behavioral Medicine, Vol. 21, Issue. 4, p. 590.

    Marijnissen, Radboud M. Smits, Johanna E.M.P. Schoevers, Robert A. van den Brink, Rob H.S. Holewijn, Suzanne Franke, Barbara de Graaf, Jacqueline and Oude Voshaar, Richard C. 2013. Association between metabolic syndrome and depressive symptom profiles—Sex-specific?. Journal of Affective Disorders, Vol. 151, Issue. 3, p. 1138.

    Meijer, Anna Zuidersma, Marij and de Jonge, Peter 2013. Depression as a non-causal variable risk marker in coronary heart disease. BMC Medicine, Vol. 11, Issue. 1,

    Aberg, M. A. I. Waern, M. Nyberg, J. Pedersen, N. L. Bergh, Y. Aberg, N. D. Nilsson, M. Kuhn, H. G. and Toren, K. 2012. Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish prospective population-based study. The British Journal of Psychiatry, Vol. 201, Issue. 5, p. 352.

    Lederbogen, F. and Ströhle, A. 2012. Stress, psychische Erkrankungen und koronare Herzkrankheit. Der Nervenarzt, Vol. 83, Issue. 11, p. 1448.

    Moretti, Rita Torre, Paola Antonello, Rodolfo M. Esposito, Francesca and Bellini, Giuseppe 2011. Gait and Equilibrium in Subcortical Vascular Dementia. Current Gerontology and Geriatrics Research, Vol. 2011, p. 1.


Depressive symptom clusters are differentially associated with atherosclerotic disease

  • B. A. A. Bus (a1), R. M. Marijnissen (a1) (a2), S. Holewijn (a3), B. Franke (a1) (a4), N. Purandare (a5), J. de Graaf (a3), M. den Heijer (a3) (a6), J. K. Buitelaar (a7) and R. C. Oude Voshaar (a1) (a5) (a8)
  • DOI:
  • Published online: 10 December 2010

Depression increases the risk of subsequent vascular events in both cardiac and non-cardiac patients. Atherosclerosis, the underlying process leading to vascular events, has been associated with depression. This association, however, may be confounded by the somatic-affective symptoms being a consequence of cardiovascular disease. While taking into account the differentiation between somatic-affective and cognitive-affective symptoms of depression, we examined the association between depression and atherosclerosis in a community-based sample.


In 1261 participants of the Nijmegen Biomedical Study (NBS), aged 50–70 years and free of stroke and dementia, we measured the intima–media thickness (IMT) of the carotid artery as a measure of atherosclerosis and we assessed depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis (PCA) of the BDI items yielded two factors, representing a cognitive-affective and a somatic-affective symptom cluster. While correcting for confounders, we used separate multiple regression analyses to test the BDI sum score and both depression symptom clusters.


We found a significant correlation between the BDI sum score and the IMT. Cognitive-affective, but not somatic-affective, symptoms were also associated with the IMT. When we stratified for coronary artery disease (CAD), the somatic-affective symptom cluster correlated significantly with depression in both patients with and patients without CAD.


The association between depressive symptoms and atherosclerosis is explained by the somatic-affective symptom cluster of depression. Subclinical vascular disease thus may inflate depressive symptom scores and may explain why treatment of depression in cardiac patients hardly affects vascular outcome.

Corresponding author
*Address for correspondence: B. A. A. Bus, M.D., Department of Psychiatry, Radboud University Nijmegen (RUN) Medical Centre, Reinier Postlaan 10, 6525GC Nijmegen, The Netherlands. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

GS Alexopoulos (2005). Depression in the elderly. Lancet 365, 19611970.

JC Barefoot , MJ Helms , DB Mark , JA Blumenthal , RM Califf , TL Haney , CM O'Connor , IC Siegler , RB Williams (1996). Depression and long-term mortality risk in patients with coronary artery disease. American Journal of Cardiology 78, 613617.

AT Beck , RA Steer (1984). Internal consistencies of the original and revised Beck Depression Inventory. Journal of Clinical Psychology 40, 13651367.

ML Bots , AW Hoes , PJ Koudstaal , A Hofman , DE Grobbee (1997). Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 96, 14321437.

ML Bots , A Hofman , PT de Jong , DE Grobbee (1996). Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid artery. The Rotterdam Study. Annals of Epidemiology 6, 147153.

RM Carney , KE Freedland (2009 a). Depression and heart rate variability in patients with coronary heart disease. Cleveland Clinical Journal of Medicine 76 (Suppl. 2), S13S17.

RM Carney , KE Freedland (2009 b). Treatment-resistant depression and mortality after acute coronary syndrome. American Journal of Psychiatry 166, 410417.

RM Carney , MW Rich , KE Freedland , J Saini , A teVelde , C Simeone , K Clark (1988). Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosomatic Medicine 50, 627633.

CS Chen , CC Chen , YT Kuo , IC Chiang , CH Ko , HF Lin (2006). Carotid intima-media thickness in late-onset major depressive disorder. International Journal of Geriatric Psychiatry 21, 3642.

KW Davidson , MM Burg , IM Kronish , D Shimbo , L Dettenborn , R Mehran , D Vorchheimer , L Clemow , JE Schwartz , F Lesperance , N Rieckmann (2010). Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome. Archives of General Psychiatry 67, 480488.

P de Jonge (2009). The importance of incident depression in myocardial infarction patients. Biological Psychiatry 65, e7e8.

P de Jonge , J Ormel , RH van den Brink , JP van Melle , TA Spijkerman , A Kuijper , DJ van Veldhuisen , MP van den Berg , A Honig , HJ Crijns , AH Schene (2006 a). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry 163, 138144.

P de Jonge , RH van den Brink , TA Spijkerman , J Ormel (2006 b). Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events. Journal of the American College of Cardiology 48, 22042208.

F Doyle , R Conroy , H McGee , M Delaney (2010). Depressive symptoms in persons with acute coronary syndrome: specific symptom scales and prognosis. Journal of Psychosomatic Research 68, 121130.

M Elovainio , L Keltikangas-Jarvinen , M Kivimaki , L Pulkki , S Puttonen , T Heponiemi , M Juonala , JS Viikari , OT Raitakari (2005). Depressive symptoms and carotid artery intima-media thickness in young adults: the Cardiovascular Risk in Young Finns Study. Psychosomatic Medicine 67, 561567.

AH Glassman , CM O'Connor , RM Califf , K Swedberg , P Schwartz , Jr. JT Bigger , KR Krishnan , LT van Zyl , JR Swenson , MS Finkel , C Landau , PA Shapiro , CJ Pepine , J Mardekian , WM Harrison , D Barton , M McIvor (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. Journal of the American Medical Association 288, 701709.

S Holewijn , M den Heijer , DW Swinkels , AF Stalenhoef , J de Graaf (2009). Brachial artery diameter is related to cardiovascular risk factors and intima-media thickness. European Journal of Clinical Investigation 39, 554560.

EH Hoogendoorn , AR Hermus , F de Vegt , HA Ross , AL Verbeek , LA Kiemeney , DW Swinkels , FC Sweep , M den Heijer (2006). Thyroid function and prevalence of anti-thyroperoxidase antibodies in a population with borderline sufficient iodine intake: influences of age and sex. Clinical Chemistry 52, 104111.

DJ Jones , JT Bromberger , K Sutton-Tyrrell , KA Matthews (2003). Lifetime history of depression and carotid atherosclerosis in middle-aged women. Archives of General Psychiatry 60, 153160.

KS Kendler , CO Gardner , A Fiske , M Gatz (2009). Major depression and coronary artery disease in the Swedish twin registry: phenotypic, genetic, and environmental sources of comorbidity. Archives of General Psychiatry 66, 857863.

DM Kriegsman , BW Penninx , JT van Eijk , AJ Boeke , DJ Deeg (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self-reports and on determinants of inaccuracy. Journal of Clinical Epidemiology 49, 14071417.

KR Krishnan , WD Taylor , DR McQuoid , JR MacFall , ME Payne , JM Provenzale , DC Steffens (2004). Clinical characteristics of magnetic resonance imaging-defined subcortical ischemic depression. Biological Psychiatry 55, 390397.

F Lesperance , N Frasure-Smith , D Koszycki , MA Laliberte , LT van Zyl , B Baker , JR Swenson , K Ghatavi , BL Abramson , P Dorian , MC Guertin (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. Journal of the American Medical Association 297, 367379.

TG Lindgren , Y Fukuoka , SH Rankin , BA Cooper , D Carroll , YL Munn (2008). Cluster analysis of elderly cardiac patients' prehospital symptomatology. Nursing Research 57, 1423.

SE Linke , T Rutledge , BD Johnson , V Vaccarino , V Bittner , CE Cornell , W Eteiba , DS Sheps , DS Krantz , S Parashar , CN Bairey Merz (2009). Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: a report from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation. Archives of General Psychiatry 66, 499507.

J Nijm , M Kristenson , AG Olsson , L Jonasson (2007). Impaired cortisol response to acute stressors in patients with coronary disease. Implications for inflammatory activity. Journal of Internal Medicine 262, 375384.

SS Pedersen , J Denollet , J Daemen , M van de Sande , PT de Jaegere , PW Serruys , RA Erdman , RT van Domburg (2007). Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents. Journal of Psychosomatic Research 62, 455461.

C Pizzi , L Manzoli , S Mancini , GM Costa (2008). Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function. European Heart Journal 29, 11101117.

CL Raison , L Capuron , AH Miller (2006). Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends in Immunology 27, 2431.

JF Scherrer , H Xian , KK Bucholz , SA Eisen , MJ Lyons , J Goldberg , M Tsuang , WR True (2003). A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosomatic Medicine 65, 548557.

FM Shrive , H Stuart , H Quan , WA Ghali (2006). Dealing with missing data in a multi-question depression scale: a comparison of imputation methods. BMC Medical Research Methodology 6, 57.

PJ Smith , JA Blumenthal , MA Babyak , PM Doraiswamy , A Hinderliter , BM Hoffman , R Waugh , A Sherwood (2009). Intima-media thickness and age of first depressive episode. Biological Psychology 80, 361364.

C Spitzer , H Volzke , S Barnow , U Krohn , H Wallaschofski , J Ludemann , U John , HJ Freyberger , W Kerner , HJ Grabe (2008). Association between depression and subclinical carotid atherosclerosis in patients with Type 1 diabetes. Diabetic Medicine 25, 349354.

MJ Stampfer , FB Hu , JE Manson , EB Rimm , WC Willett (2000). Primary prevention of coronary heart disease in women through diet and lifestyle. New England Journal of Medicine 343, 1622.

DC Steffens (2004). Establishing diagnostic criteria for vascular depression. Journal of Neurological Science 226, 5962.

E ter Avest , S Holewijn , AF Stalenhoef , J de Graaf (2005). Variation in non-invasive measurements of vascular function in healthy volunteers during daytime. Clinical Science (London) 108, 425431.

H Tiemeier , MM Breteler , NM van Popele , A Hofman , JC Witteman (2003). Late-life depression is associated with arterial stiffness: a population-based study. Journal of the American Geriatric Society 51, 11051110.

H Tiemeier , W van Dijck , A Hofman , JC Witteman , T Stijnen , MM Breteler (2004). Relationship between atherosclerosis and late-life depression: the Rotterdam Study. Archives of General Psychiatry 61, 369376.

K Van der Kooy , H van Hout , H Marwijk , H Marten , C Stehouwer , A Beekman (2007). Depression and the risk for cardiovascular diseases: systematic review and meta analysis. International Journal of Geriatric Psychiatry 22, 613626.

JP van Melle , P de Jonge , A Honig , AH Schene , AM Kuyper , HJ Crijns , A Schins , D Tulner , MP van den Berg , J Ormel (2007). Effects of antidepressant treatment following myocardial infarction. British Journal of Psychiatry 190, 460466.

SA Vreeburg , WJ Hoogendijk , J van Pelt , RH Derijk , JC Verhagen , R van Dyck , JH Smit , FG Zitman , BW Penninx (2009). Major depressive disorder and hypothalamic-pituitary-adrenal axis activity: results from a large cohort study. Archives of General Psychiatry 66, 617626.

L Wouts , RC Oude Voshaar , MA Bremmer , JK Buitelaar , BW Penninx , AT Beekman (2008). Cardiac disease, depressive symptoms, and incident stroke in an elderly population. Archives of General Psychiatry 65, 596602.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *