Is having cardiovascular disease in a spouse associated with an increased risk of depression?

Is having cardiovascular disease in a spouse associated with an increased risk of depression?

Cardiovascular diseases (CVD) are one of the most common causes of illness and death today. While cardiovascular disease has long been associated with the onset of depression, not much is known about whether sufferers' spouses are more likely to develop depression following such events.

A recently published study inJAMA network openedinvestigated this topic and laid the foundation for future prospective studies in this area.

Depression and health

Depression is 65% more common and is considered the most common mental disorder worldwide, not only affecting quality of life but also negatively impacting overall health.

Depression is associated with a higher risk of cardiovascular disease, dementia, poor cognition and death.

How is cardiovascular disease related to depression?

Both cardiovascular disease and depression are more common in overweight people and both share inflammation in the immune system. When someone suffers a cardiovascular event such as a stroke or heart attack, the family also suffers psychological stress, anxiety and even depression.

The current study aimed to examine the association between cardiovascular disease and depression at the household level. Data came from a national database of the Japan Health Insurance Association (JHIA).

This included about 40% of Japan's working-age population, or 30 million people in this age group.

What did the study show?

Researchers found that of nearly 278,000 married couples who shared key characteristics, the vast majority (95%) reported a cardiovascular event in the male partner. The average age of the patients was 58 years.

Those whose spouses had a cardiovascular event were more likely to have diabetes, high blood pressure or depression compared to the other group. There was an increased cumulative incidence of depression in the spouse group, between 4% and 5% in men and women, respectively.

Among spouses between the ages of 20 and 59, about 4% experienced depression, compared to 3% of those over 60.

New-onset depression was observed in almost 2% of individuals. The spousal risk of depression following a cardiovascular disease was 13% higher than in the group without such an event.

This showed no change by age, gender, income or previous history of CVD.

However, the risk of depression was 13 to 15% higher after a marital stroke or heart failure, but not after a heart attack.

Other potentially confounding factors included smoking, drinking, exercise, or whether the index patient was taking medication to lower blood pressure. However, none of these showed an impact on the spouse's risk of depression.

The researchers also examined the possible interaction of these results with the health status of the spouse.

They examined body mass index (BMI), blood pressure, cholesterol levels, blood sugar concentrations and kidney function. They found that the same increased risk occurred even after controlling for these factors.

The study confirms the depressive effect of a cardiovascular event in marriage, which could result in the need to care for the sick spouse.

This can mean inevitable lifestyle changes, lack of other social interactions, sleep problems and lack of exercise. All of this is accompanied by chronic psychological stress, which increases with the level and duration of care.

Another source of stress is financial problems due to the forced loss of a job to meet the needs of the spouse, coupled with additional care costs.

Finally, grief over the loss of a spouse or grief related to a loved one's stay in the intensive care unit can trigger depression.

Conclusions

“These results underscore the importance of mental health screening among individuals whose spouses suffer from cardiovascular disease.”

By taking into account possible confounding factors such as history of other diseases, individual practice of healthy habits and physical health parameters, the study fills a knowledge gap and provides stronger evidence.

Community-level and multidisciplinary clinical support systems should be explored as a possible intervention to reduce this risk for spouses of cardiovascular patients through a broad prevention approach.

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