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Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish prospective population-based study

  • Maria A. I. Åberg (a1), Margda Waern (a2), Jenny Nyberg (a3), Nancy L. Pedersen (a4), Ylva Bergh (a5), N. David Åberg (a6), Michael Nilsson (a3), H. Georg Kuhn (a3) and Kjell Torén (a7)...
Abstract
Background

Studies suggest a role for cardiovascular fitness in the prevention of affective disorders.

Aims

To determine whether cardiovascular fitness at age 18 is associated with future risk of serious affective illness.

Method

Population-based Swedish cohort study of male conscripts (n = 1 117 292) born in 1950–1987 with no history of mental illness who were followed for 3–40 years. Data on cardiovascular fitness at conscription were linked with national hospital registers to calculate future risk of depression (requiring in-patient care) and bipolar disorder.

Results

In fully adjusted models low cardiovascular fitness was associated with increased risk for serious depression (hazard ratios (HR)=1.96, 95%, CI 1.71–2.23). No such association could be shown for bipolar disorder (HR=1.11, 95% CI 0.84–1.47).

Conclusions

Lower cardiovascular fitness at age 18 was associated with increased risk of serious depression in adulthood. These results strengthen the theory of a cardiovascular contribution to the aetiology of depression.

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Copyright
Corresponding author
H. Georg Kuhn, PhD, Institute for Neuroscience and Physiology, University of Gothenburg, Medicinaregatan 11, Box 432, S-40530 Gothenburg, Sweden. Email: Georg.Kuhn@neuro.gu.se
Footnotes
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See editorial, pp. 337-338, this issue.

Declaration of interest

None.

Footnotes
References
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Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish prospective population-based study

  • Maria A. I. Åberg (a1), Margda Waern (a2), Jenny Nyberg (a3), Nancy L. Pedersen (a4), Ylva Bergh (a5), N. David Åberg (a6), Michael Nilsson (a3), H. Georg Kuhn (a3) and Kjell Torén (a7)...
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eLetters

Depression and cardiovascular fitness: interrelated markers of autonomic nervous system development?

Annie Swanepoel, Child and Adolescent Psychiatry Trainee
05 December 2012

The paper by Aberg (1) finds that low cardiovascular fitness in youngconscripts is significantly associated with an increased risk for serious depression. The authors state "these results strengthen the theory of a cardiovascular contribution to the aetiology of depression". However, there is an alternative explanation, which will avoid the inadequacy of the "simple chicken-or-egg models in which depression causes cardiovascular disease or vice versa", as de Jonge and Roest warn against in the accompanying editorial (2).The alternative explanation is that both depression and cardiovascular disease are independent markers of a suboptimally developed autonomic nervous system. Schore has found that the development of both the sympathetic and parasympathetic branches of the autonomic nervous system are influenced by the environment. The evidence is accumulating that if a child has a sensitive and predictable caregiver, he or she is more likely to develop a secure attachment (3). This is characterized by an optimal autonomic nervous system development, specifically allowing the ventral branch of the parasympathetic nerve, also known as the "smart vagus" to bein control. This enables mature emotion regulation, as well as simultaneously also increasing heart rate variability (3) (4). In childrenwho are less fortunate in their early caregiving, the smart vagus may not be as active, resulting in a) poor emotion regulation, which may predispose them to later depression, as well as b) reduced heart rate variability, which may predispose to poor fitness and cardiovascular disorders in later life (5).Measuring autonomic balance in preschoolers, and linking this with both later depression and cardiovascular disorders could test this theory. It is likely that such a study would end the chicken-or-egg mentality and help us to think of both cardiovascular illnesses and depression to be markers of poor "smart vagus" parasympathetic development. Instead of exclusively focusing on getting depressed people to exercise, or treating depression in people with heart disorders, it may make more sense to direct interventions to very early mother-infant interactions, in order toreduce the risk for both psychological and physical problems later in life.

1.Aberg MAI, Waern M, Nyberg J, Pedersen NL, Bergh Y, Aberg ND, et al. Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish prospective population-based study. The British Journal Of Psychiatry: The Journal Of Mental Science. 2012; 201: 352-9.2.de Jonge P, Roest AM. Depression and cardiovascular disease: the end ofsimple models. The British Journal Of Psychiatry: The Journal Of Mental Science. 2012; 201: 337-8.3.Schore AN. Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal. 2001; 22(1/2): 7-66.4.Beauchaine TP, Gatzke-Kopp L, Mead HK. Polyvagal Theory and developmental psychopathology: emotion dysregulation and conduct problems from preschool to adolescence. Biological Psychology. 2007; 74(2): 174-84.5.Porges SWFSA. The early development of the autonomic nervous system provides a neural platform for social behaviour: a polyvagal perspective. Infant & Child Development. 2011; 20(1): 106-18.

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Conflict of interest: None declared

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