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

Charlson, Fiona J., Moran, Andrew, Freedman, Greg, Norman, Rosana E., Stapelberg, Nicolas J.C., Baxter, Amanda J., Vos, Theo, & Whiteford, Harvey A. (2013) The contribution of major depression to the global burden of ischemic heart disease : a comparative risk assessment. BMC Medicine, 11(250).

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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.

Impact and interest:

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ID Code: 79822
Item Type: Journal Article
Refereed: Yes
Keywords: Burden of disease, Comparative risk assessment, Depression, Ischemic heart disease, article, comparative study, DSM-IV, Eastern Europe, human, income, International Classification of Diseases, major depression, Middle East, mortality, North Africa, risk assessment, risk factor, systematic review, Adult, Aged, Aged, 80 and over, Cost of Illness, Depressive Disorder, Major, Female, Humans, Male, Middle Aged, Myocardial Ischemia, Risk Factors, World Health
DOI: 10.1186/1741-7015-11-250
ISSN: 1741-7015
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700) > Epidemiology (111706)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700) > Mental Health (111714)
Australian and New Zealand Standard Research Classification
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2013 Charlson et al.; licensee BioMed Central Ltd. T
Copyright Statement: This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Deposited On: 15 Jan 2015 00:39
Last Modified: 20 Jan 2015 06:10

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