Depression, Low Income Increase Risk for HF in High-Risk Black Patients

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Investigators evaluated the relationship between heart failure, depressive symptoms, income, and race.

Incident heart failure (HF) was associated with depressive symptoms among a cohort of high-risk, low-income, predominantly Black individuals. These findings were published in the Journal of the American College of Cardiology.

The Southern Community Cohort Study was a prospective study conducted in 12 southeastern states between 2002 and 2009. Adults aged 40 to 79 years (N=84,797) were recruited from community health centers. This study assessed the incidence of HF among a subset of 23,937 participants on the basis of depressive symptoms ascertained by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Clinically relevant depression was defined as a score of greater than or equal to 10 points.

Study participants had a CESD-10 score of less than 10 (n=13,176), 10 to 19 (n=8837), or greater than or equal to 20 (n=1924) points. These cohorts were aged median 57, 51, and 49 years (P <.001); 60%, 66%, and 78% were women (P <.001); 71%, 72%, and 59% were Black (P <.001); 19%, 12%, and 8% were employed (P <.001); and 16%, 36%, and 59% used antidepressants or anxiolytics (P <.001), respectively.

In general, individuals who were smokers, consumed more alcohol, had fewer friends or less social support, and were more sedentary had higher CESD-10 scores.

After a median follow-up of 11 years, 6081 individuals developed HF.

In the fully adjusted model accounting for age, gender, ethnicity, comorbidities, income, education, employment status, smoking status, alcohol consumption, physical activity, marital status, number of close friendships, and use of antidepressants, CESD-10 scores per 8-point increase remained a significant predictor of incident HF (hazard ratio [HR], 1.04; 95% CI, 1.00-1.09; P =.038).

Stratified by antidepressant use, increasing CESD-10 scores associated with 5-year HF probability among individuals not using antidepressants (HR, 1.07; 95% CI, 1.02-1.12; P =.006).

The findings of this study may not be generalizable to other populations. In a comparison with other large cohort studies, conflicting findings have been published about the relationship between symptoms of depression and incident HF.

“In a large, high risk, low-income, and predominantly Black cohort from the southeastern United States, depressive symptoms significantly associate with greater risk of incident HF,” the researchers wrote. “In this cohort, depression is very common and a potentially modifiable mechanism contributing to the increased risk of HF, particularly in populations with less favorable social determinants of health.”


Dixon DD, Xu M, Akwo EA, Nair D, et al. Depressive symptoms and incident heart failure risk in the Southern Community Cohort Study. J Am Coll Cardiol HF. Published online February 9, 2022. doi: 10.1016/j.jchf.2021.11.007