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The Rotterdam Study

Henning Tiemeier, MD, PhD; Wim van Dijck, MSc; Albert Hofman, MD, PhD; Jacqueline C. M. Witteman, PhD; Theo Stijnen, PhD; Monique M. B. Breteler, MD, PhD

Arch Gen Psychiatry. 2004;61:369-376.

Context  Depression in late life has been associated with vascular abnormalities. Several studies have demonstrated that persons with brain infarcts are more likely to have depressive disorders. Furthermore, depression is related to the subsequent development of ischemic heart disease.

Objective  To investigate the relationship between atherosclerosis at different locations and depression in the general population.

Design  Cross-sectional population-based study.

Setting  The Rotterdam Study, a population-based cohort study.

Participants  In 4019 men and women 60 years and older, we assessed atherosclerosis at different locations, including common carotid intima-media thickness, plaques in the carotid arteries, the ankle-brachial blood pressure index, and aortic atherosclerosis. An overall measure of extracoronary atherosclerosis was obtained in 3747 persons by computing the principal component of these extracoronary atherosclerosis measures. In a subgroup of 1986 persons, we additionally measured coronary calcifications.

Main Outcome Measure  All subjects were screened for depressive symptoms. Screen-positive subjects had a psychiatric interview to diagnose depressive disorder.

Results  More severe extracoronary atherosclerosis was associated with a higher prevalence of depressive disorders. For every 1–standard deviation increase, the prevalence increased by 30%. Furthermore, we found a strong relationship of severe coronary and aortic calcifications with depressive disorders (odds ratio, 3.89; 95% confidence interval, 1.55-9.77; and odds ratio, 2.00; 95% confidence interval, 1.02-3.96, respectively).

Conclusions  Atherosclerosis and depression are associated in the elderly. This finding is compatible with the vascular depression hypothesis. However, the cross-sectional nature of the study does not allow causal inferences. In particular, earlier depressive episodes may have contributed to the development of atherosclerosis.

From the Departments of Epidemiology and Biostatistics (Drs Tiemeier, Hofman, Witteman, Stijnen, and Breteler and Mr van Dijck) and Child and Adolescent Psychiatry (Dr Tiemeier), Erasmus Medical Center, Rotterdam, the Netherlands.

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