Depression and mortality: Artifact of measurement and analysis?

K M Appleton, J V Woodside, D Arveiler, B Haas, P Amouyel, M Montaye, J Ferrieres, J B Ruidavets, J W G Yarnell, F Kee, A Evans, A Bingham, P Ducimetiere, Christopher Patterson, PRIME study group

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: Previous research demonstrates various associations between depression, cardiovascular disease (CVD) incidence and mortality, possibly as a result of the different methodologies used to measure depression and analyse relationships. This analysis investigated the association between depression, CVD incidence (CVDI) and mortality from CVD (MCVD), smoking related conditions (MSRC), and all causes (MALL), in a sample data set, where depression was measured using items from a validated questionnaire and using items derived from the factor analysis of a larger questionnaire, and analyses were conducted based on continuous data and grouped data.

Methods: Data from the PRIME Study (N=9798 men) on depression and 10-year CVD incidence and mortality were analysed using Cox proportional hazards models.

Results: Using continuous data, both measures of depression resulted in the emergence of positive associations between depression and mortality (MCVD, MSRC, MALL). Using grouped data, however, associations between a validated measure of depression and MCVD, and between a measure of depression derived from factor analysis and all measures of mortality were lost.

Limitations: Low levels of depression, low numbers of individuals with high depression and low numbers of outcome events may limit these analyses, but levels are usual for the population studied.

Conclusions: These data demonstrate a possible association between depression and mortality but detecting this association is dependent on the measurement used and method of analysis. Different findings based on methodology present clear problems for the elucidation and determination of relationships. The differences here argue for the use of validated scales where possible and suggest against over-reduction via factor analysis and grouping.
Original languageEnglish
Pages (from-to)632-8
Number of pages7
JournalJournal of Affective Disorders
Issue number2
Early online date29 Jul 2013
Publication statusPublished - Nov 2013

Bibliographical note

Crown Copyright © 2013 Published by Elsevier B.V. All rights reserved.


  • Cardiovascular Diseases
  • Depression
  • Depressive Disorder
  • Factor Analysis, Statistical
  • France
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Northern Ireland
  • Proportional Hazards Models
  • Questionnaires
  • Smoking
  • Tobacco Use Disorder


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