Depressive symptoms and sleep problems as risk factors for heart disease: a prospective community study

Epidemiol Psychiatr Sci. 2019 Aug 20;29:e50. doi: 10.1017/S2045796019000441.


Aims: The goals of the present study were to examine the associations between depressive symptoms, sleep problems and the risk of developing heart disease in a Canadian community sample.

Methods: Baseline data were from the CARTaGENE study, a community health survey of adults aged 40-69 years in Quebec, Canada. Incidence of heart disease was examined in N = 33 455 participants by linking survey data with administrative health insurance data. Incident heart disease was identified using the World Health Organization's International Classification of Diseases, 9th or 10th edition (ICD-9 and ICD-10) diagnostic codes for heart disease. Sleep problems were assessed with diagnostic codes for sleep disorders within the 2 years preceding the baseline assessment. Average sleep duration was assessed by self-report. Depressive symptoms were assessed with the nine-item Patient Health Questionnaire.

Results: In total, 2448 (7.3%) participants developed heart disease over an average follow-up period of 4.6 years. Compared to those without depressive symptoms and with no sleep disorders, those with elevated depressive symptoms and a sleep disorder (HR = 2.60, 95% CI 1.83-3.69), those with depressive symptoms alone (HR = 1.40, 95% CI 1.25-1.57) and those with sleep disorders alone (HR = 1.33, 95% CI 1.03-1.73) were more likely to develop heart disease. Test of additive interaction suggested a synergistic interaction between depressive symptoms and sleep disorders (synergy index = 2.17 [95% CI 1.01-4.64]). When sleep duration was considered, those with long sleep duration and elevated depressive symptoms were more likely to develop heart disease than those with long sleep alone (HR = 1.77, 95% CI 1.37-2.28; and HR = 1.16, 95% CI 0.99-1.36, respectively).

Conclusions: Depression and diagnosed sleep disorders or long sleep duration are independent risk factors for heart disease and are associated with a stronger risk of heart disease when occurring together.

Keywords: Depression; epidemiology; health outcomes; sleep.

MeSH terms

  • Adult
  • Aged
  • Canada / epidemiology
  • Coronary Disease / epidemiology*
  • Depression / epidemiology*
  • Female
  • Heart Failure / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Patient Health Questionnaire
  • Prospective Studies
  • Quebec / epidemiology
  • Risk Factors
  • Sleep Wake Disorders / epidemiology*