Department of Biological and Health Sciences, University of Brasilia, Campus Universitario - Centro Metropolitano, Ceilandia Campus. Brasilia, FD 72220-275, Brazil; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
Prev Med. 2021 Jan;142:106378. doi: 10.1016/j.ypmed.2020.106378. Epub 2020 Dec 17.
Depression is associated with poor cardiovascular health (CVH) and increased risk of cardiovascular disease in high-income countries. However, it is unclear whether depression, particularly somatic depressive symptoms, may similarly contribute to poor CVH in a different socioeconomic context. Our aim was to investigate the association between depression and CVH in Brazil, a middle-income country. 49,658 participants (≥18 years) from the 2013 National Health Survey-Brazil. Favorable CVH was defined by meeting recommended levels on five CVH components (blood pressure, body mass index, diabetes or hypercholesterolemia status, smoking status). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9; depressed if score ≥ 10). Two PHQ-9 sub-domain scores (somatic or cognitive symptoms) were also considered. Covariates included age, sex, race, income, education, region of residence, marital status, chronic diseases, diet and physical activity. Depression was associated with a 27% lower odds of having favorable CVH (OR 0.73; 95%CI 0.62-0.86), and the association was stronger among women (OR 0.72; 95%CI 0.60-0.86). Both somatic and cognitive depression symptoms were inversely associated with lower odds of having favorable CVH. In conclusion, depression is associated with lower odds of having favorable CVH in Brazil, and associations are evident across both somatic and cognitive components of depression. Moreover, the relationship was independent of socioeconomic factors, chronic diseases, and was not strongly explained by diet or physical activity. Overall, our findings suggest that the greater odds of having poor CVH among depressed individuals is not unique to high-income countries.
抑郁与心血管健康不良（CVH）和高收入国家心血管疾病风险增加有关。然而，目前尚不清楚抑郁，尤其是躯体性抑郁症状，是否在不同的社会经济环境下同样会导致 CVH 不良。我们的目的是研究抑郁与巴西这一中等收入国家的 CVH 之间的关系。49658 名（≥18 岁）参与者来自 2013 年巴西全国健康调查。良好的 CVH 通过满足五个 CVH 指标（血压、体重指数、糖尿病或高胆固醇血症状态、吸烟状况）的推荐水平来定义。抑郁使用患者健康问卷-9（PHQ-9；评分≥10 分为抑郁）进行评估。还考虑了 PHQ-9 的两个亚域评分（躯体症状或认知症状）。协变量包括年龄、性别、种族、收入、教育、居住地、婚姻状况、慢性病、饮食和体育活动。抑郁与 CVH 良好的可能性降低 27%相关（OR 0.73；95%CI 0.62-0.86），并且在女性中这种相关性更强（OR 0.72；95%CI 0.60-0.86）。躯体性和认知性抑郁症状均与 CVH 良好的可能性降低呈负相关。总之，抑郁与巴西人 CVH 良好的可能性降低相关，且这种相关性在躯体性和认知性抑郁症状的两个组成部分中都很明显。此外，这种关系独立于社会经济因素、慢性疾病，并且不能很好地用饮食或体育活动来解释。总的来说，我们的研究结果表明，抑郁者 CVH 不良的几率较高并非高收入国家所特有。
