Depression as a predictor for coronary heart disease. a review and meta-analysis

Am J Prev Med. 2002 Jul;23(1):51-61. doi: 10.1016/s0749-3797(02)00439-7.


Objective: To review and quantify the impact of depression on the development of coronary heart disease (CHD) in initially healthy subjects.

Data sources: Cohort studies on depression and CHD were searched in MEDLINE (1966-2000) and PSYCHINFO (1887-2000), bibliographies, expert consultation, and personal reference files.

Data selection: Cohort studies with clinical depression or depressive mood as the exposure, and myocardial infarction or coronary death as the outcome.

Data extraction: Information on study design, sample size and characteristics, assessment of depression, outcome, number of cases, crude and most-adjusted relative risks, and variables used in multivariate adjustments were abstracted.

Data synthesis: Eleven studies met the inclusion criteria. The overall relative risk [RR] for the development of CHD in depressed subjects was 1.64 (95% confidence interval [CI]=1.29-2.08, p<0.001). A sensitivity analysis showed that clinical depression (RR=2.69, 95% CI=1.63-4.43, p<0.001) was a stronger predictor than depressive mood (RR=1.49, 95% CI=1.16-1.92, p=0.02).

Conclusion: It is concluded that depression predicts the development of CHD in initially healthy people. The stronger effect size for clinical depression compared to depressive mood points out that there might be a dose-response relationship between depression and CHD. Implications of the findings for a broader bio-psycho-social framework are discussed.

Publication types

  • Meta-Analysis
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Disease / etiology*
  • Depression / complications*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity