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The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment.

Charlson FJ, Moran AE, Freedman G, Norman RE, Stapelberg NJ, Baxter AJ, Vos T, Whiteford HA - BMC Med (2013)

Bottom Line: As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010.Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.The present work comprises the most robust systematic review of its kind to date.

View Article: PubMed Central - HTML - PubMed

Affiliation: Queensland Centre for Mental Health Research, Brisbane, Australia. fiona_charlson@qcmhr.uq.edu.au.

ABSTRACT

Background: Cardiovascular disease and mental health both hold enormous public health importance, both ranking highly in results of the recent Global Burden of Disease Study 2010 (GBD 2010). For the first time, the GBD 2010 has systematically and quantitatively assessed major depression as an independent risk factor for the development of ischemic heart disease (IHD) using comparative risk assessment methodology.

Methods: A pooled relative risk (RR) was calculated from studies identified through a systematic review with strict inclusion criteria designed to provide evidence of independent risk factor status. Accepted case definitions of depression include diagnosis by a clinician or by non-clinician raters adhering to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) classifications. We therefore refer to the exposure in this paper as major depression as opposed to the DSM-IV category of major depressive disorder (MDD). The population attributable fraction (PAF) was calculated using the pooled RR estimate. Attributable burden was calculated by multiplying the PAF by the underlying burden of IHD estimated as part of GBD 2010.

Results: The pooled relative risk of developing IHD in those with major depression was 1.56 (95% CI 1.30 to 1.87). Globally there were almost 4 million estimated IHD disability-adjusted life years (DALYs), which can be attributed to major depression in 2010; 3.5 million years of life lost and 250,000 years of life lived with a disability. These findings highlight a previously underestimated mortality component of the burden of major depression. As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010. Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.

Conclusions: The present work comprises the most robust systematic review of its kind to date. The key finding that major depression may be responsible for approximately 3% of global IHD DALYs warrants assessment for depression in patients at high risk of developing IHD or at risk of a repeat IHD event.

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Change in ischemic heart disease (IHD) disability-adjusted life years (DALYs) attributable to major depression over time, by age.
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Figure 3: Change in ischemic heart disease (IHD) disability-adjusted life years (DALYs) attributable to major depression over time, by age.

Mentions: The IHD burden attributable to major depression has increased over time from 3.0 million DALYs in 1990 to 3.8 million DALYs in 2010 (FigureĀ 3). However, the majority of this increase occurred in the 1990 to 2005 period with an apparent stabilization of burden between 2005 and 2010. This overall increase is reflective of an increase in IHD DALYs largely driven by population growth and aging [37].


The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment.

Charlson FJ, Moran AE, Freedman G, Norman RE, Stapelberg NJ, Baxter AJ, Vos T, Whiteford HA - BMC Med (2013)

Change in ischemic heart disease (IHD) disability-adjusted life years (DALYs) attributable to major depression over time, by age.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222499&req=5

Figure 3: Change in ischemic heart disease (IHD) disability-adjusted life years (DALYs) attributable to major depression over time, by age.
Mentions: The IHD burden attributable to major depression has increased over time from 3.0 million DALYs in 1990 to 3.8 million DALYs in 2010 (FigureĀ 3). However, the majority of this increase occurred in the 1990 to 2005 period with an apparent stabilization of burden between 2005 and 2010. This overall increase is reflective of an increase in IHD DALYs largely driven by population growth and aging [37].

Bottom Line: As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010.Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.The present work comprises the most robust systematic review of its kind to date.

View Article: PubMed Central - HTML - PubMed

Affiliation: Queensland Centre for Mental Health Research, Brisbane, Australia. fiona_charlson@qcmhr.uq.edu.au.

ABSTRACT

Background: Cardiovascular disease and mental health both hold enormous public health importance, both ranking highly in results of the recent Global Burden of Disease Study 2010 (GBD 2010). For the first time, the GBD 2010 has systematically and quantitatively assessed major depression as an independent risk factor for the development of ischemic heart disease (IHD) using comparative risk assessment methodology.

Methods: A pooled relative risk (RR) was calculated from studies identified through a systematic review with strict inclusion criteria designed to provide evidence of independent risk factor status. Accepted case definitions of depression include diagnosis by a clinician or by non-clinician raters adhering to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) classifications. We therefore refer to the exposure in this paper as major depression as opposed to the DSM-IV category of major depressive disorder (MDD). The population attributable fraction (PAF) was calculated using the pooled RR estimate. Attributable burden was calculated by multiplying the PAF by the underlying burden of IHD estimated as part of GBD 2010.

Results: The pooled relative risk of developing IHD in those with major depression was 1.56 (95% CI 1.30 to 1.87). Globally there were almost 4 million estimated IHD disability-adjusted life years (DALYs), which can be attributed to major depression in 2010; 3.5 million years of life lost and 250,000 years of life lived with a disability. These findings highlight a previously underestimated mortality component of the burden of major depression. As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010. Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.

Conclusions: The present work comprises the most robust systematic review of its kind to date. The key finding that major depression may be responsible for approximately 3% of global IHD DALYs warrants assessment for depression in patients at high risk of developing IHD or at risk of a repeat IHD event.

Show MeSH
Related in: MedlinePlus