Table 2.
Studies Investigating the Relationship between Vascular Risk Factors and Depression in Older Black Americans
| Study Design (Bias Rating) |
N | Age Range or M (SD) |
% Black |
Depression Measure |
Depression Criteria |
Vascular Risk Factors (VRF) Examined |
Main Findings | |
|---|---|---|---|---|---|---|---|---|
| Self-Report Measures of VD/VRF | ||||||||
| Azar et al. 2005 | Cross-sectional (7) | 362* | 55+ | 50 | CES-D | CES-D ≥ 18 (highest quartile) | HTN, heart disease, diabetes, arteriosclerosis. High Risk: ≥ 2, Low Risk: ≤ 1 | ≥ 2 VRFs increased risk of depression across race. No race differences in prevalence of VRFs. No race by VRF interaction to predict depression. |
| Baker et al., 1996 | Cross-sectional (5) | 96* | 60+ | 100 | CES-D | CES-D ≥ 16 | HTN, arteriosclerosis, circulatory problems | Depressed group had higher frequency of hypertension, arteriosclerosis, & circulatory problems, but not arthritis. |
| Carmasin et al., 2014 | Longitudinal (7) | 435* |
69 (9) | 100 | CES-D | CES-D ≥ 16 | HTN, diabetes, cardiovascular disease, heart attack, angina, circulatory problems, stroke. High Risk: ≥ 2, Low Risk: ≤ 1 | ≥ 2 VRFs predicted depression at 2.5 year follow-up regardless of baseline depression level. High-risk group was 2.61x more likely to develop depression than low risk group. High baseline vascular risk predicted worsening depression over time. Baseline vascular risk had a small, negative effect on processing speed. |
| Gonzalez & Tarraf, 2013 | Cross-sectional (7) | 4,281* | 50+ | 40 | CIDI Diagnostic Interview for DSM-IV | DSM-IV criteria for MDD | HTN, diabetes, heart disease, stroke, or “other” CVD | Black participants had the highest cardiovascular disease morbidity: 65.4% reported one or more VRF. Black pts were the least likely to meet CVD & MDD criteria (4.7%), but of those who met MDD criteria, Black pts were the most likely to have a comorbid CVD/MDD diagnosis (74.4%). Black pts reported more days of impairment compared to White. |
| Hamm et al., 1993 | Cross-sectional (5) | 710* | 62+ | 100 | CES-D | CES-D Total Score | Self-reported HTN or “cardiac problems” | CVD/HTN group was more depressed and perceived themselves as having less control over their health (health locus of control) compared to the CVD-free or HTN-only groups. |
| Okwumabua et al., 1997 | Cross-sectional (7) | 96* | 60+ | 100 | CES-D | CES-D ≥ 16 | HTN, arteriosclerosis and "circulatory" conditions | Those who screened positive for significant depressive symptoms were more likely to report HTN, arteriosclerosis, and circulatory problems. |
| Yochim et al., 2003 | Cross-sectional (5) | 598* | 60+ | 89 | SF-12 item, “How much of the time during the past 4 weeks have you felt down-hearted and blue?” | Response "all, most, or a good bit of the time" to SF-12 item | HTN, diabetes, “heart problems” such as heart attack, angina/ chest pain, or congestive heart failure. High Risk: ≥ 2, Low Risk: ≤ 1 |
Higher prevalence of depressed mood in those with ≥ 2 VRF (17%) vs. ≤ 1 VRF (10%). The difference in sick days between those with and without depressed mood was greater in those with ≥ 2 VRFs than in those with ≤ 1 VRF. |
| Yochim, Kerkar, et al., 2006 | Cross-sectional (7) | 1,034* | 72(8) | 100 | SF-12 item, “How much of the time during the past 4 weeks have you felt down-hearted and blue?” | Endorsed single item of SF-12 as "all, most, or a good bit of the time" | HTN, diabetes, “heart problem” such as heart attack or atrial fibrillation, high cholesterol. High Risk: ≥ 2, Low Risk: ≤ 1 | High risk group (excluding stroke) was more likely to have depressed mood (13.4%) compared to the low-risk group (7.6%). Greater vascular burden predicted worse physical health, physical health levels predicted depression, but physical health did not mediate the relationship between vascular burden and depression. VRFs predicted depression over and above physical health. |
| Yochim, MacNeill et al., 2006 | Longitudinal (7) | 139† | 73 (9) | 83 | GDS | GDS Total Score | HTN, diabetes, atrial fibrillation. High Risk: ≥ 2, Low Risk: ≤ 1 | At baseline and at 3- and 6-month follow-up visits, the high-risk vascular group had more depressive symptoms. Depression predicted verbal fluency at 3 and 6 months. Vascular burden did not predict verbal fluency. |
| Physician Diagnosis or Objective Measures of VD/VRF | ||||||||
| Andrews et al., 2020 | Cross-sectional (7) | 42* | 59 (12) | 99 | CESD-R | CESD-R Total Score | Interleukins (IL)-1b, IL-6, IL-18 | IL-1 B IL-18) ncreased significantly for every unit increase in depressive symptoms. |
| Boutin-Foster et al., 2008 | Cross-sectional (7) | 571† | 66 (10) | 12 | CES-D | CESD-Total Score and Item Level Scores | Coronary artery disease | Black participants were 1.6 times more likely to have CES-D symptoms above the clinical cut-off score and three times more likely to endorse the item “people were unfriendly” compared to White participants |
| Cummings et al., 2016 | Cross-sectional (7) | 22,003* | 64 (n.r.) | 42 | CESD-4 | CESD-4 ≥ 4 | Diabetes physical exam or self-report) | Those with comorbid diabetes and depression were more likely to be Black |
| Dickson et al., 2013 | Cross-sectional (7) | 30*† | 60 (15) | 100 | PHQ-9 | PHQ-9 ≥ 10 | Heart failure | 40% had significant depressive symptoms and those with depressive symptoms had poorer self-care |
| Freedland et al., 1991 | Cross-sectional (7) | 60† | 60+ | 32 | Modified Diagnostic Interview Schedule | DSM-III-R MDD Diagnosis | Congestive heart failure | 1/6 of the White sample but none of the Black sample met criteria for depression |
| Heard et al., 2011 | Cross-sectional (7) | 997* | 62 (15) | 100 | 11-item version of the CES-D | CES-D Total Score | HTN (objective and self-report) | Higher depressive symptoms were associated with lower blood pressure |
| Hajjar et al., 2009 | Cross-sectional (7) | 580* | 77.8 (0.2) | 14 | CES-D | CES-D Total Score | HTN (objective), self-report of diabetes, heart disease, heart attack, stroke, congestive heart failure, and Framingham cardiovascular risk score | Identified a “vascular aging” phenotype of older adults who have executive function impairment (TMT-B ≥ 262 s.), slow gait (<. 85m/s), and elevated depressive symptoms (CES-D ≥ 8). Members of this phenotype were significantly more likely to be Black. |
| Lamar et al., 2015 | Cross-sectional (7) | 119* | 60 (12) | 50 | 17-item HDRS ≤ 8 for inclusion; CES-D for analyses |
Total CES-D |
Metabolic Syndrome risk factors: elevated blood pressure, glucose, triglycerides, HDL, and body mass index > 30. No Risk = 0, Low Risk = 1-2, High Risk: ≥ 3 | Across race, high-risk pts reported more depressive symptoms than the no-risk and low-risk groups, and incremental metabolic syndrome risk predicted learning and memory scores (no > low = high). No individual VRF predicted depressive symptoms for Black participants. Glucose levels predicted learning scores and systolic blood pressure predicted memory scores in Black participants. |
| Lewis et al., 2009 | Cross-sectional (7) | 508* | 50 (3) | 38 | CES-D | CES-D Total Score | Aortic and coronary calcification | Depressive symptoms were associated with aortic calcification in Black women but not White women. |
| Lu et al., 2017 | Cross-sectional (7) | 611† | 66 (15) | 100 | Depression per medical records | Depression per medical records | Heart failure per medical records | Depression increased the risk for 30-day readmission in heart failure patients. |
| Mast, Neufield et al., 2004 | Longitudinal (7) | 100† | 73 (8) | 82 | GDS-SF | GDS-SF > 5 | ICD-9 codes from treating physicians for HTN, diabetes, Atrial fibrillation. High Risk: ≥ 2, Low Risk: ≤ 1 | High risk group was 5.6x more likely to have a positive depression screen at the 6-month follow-up, 5x more likely at 18 months, and more likely to have persistent depression across timepoints compared to the low risk group. Vascular burden significantly predicted new-onset depression at 6 and 18 months. |
| Mast, MacNeill, et al., 2004 | Cross-sectional (5) | 670† | 76 (8.0) | 68-82 across groups |
GDS | GDS >10 | ICD-9 diagnosis of stroke, HTN, diabetes, atrial fibrillation | There was no difference in prevalence of depression across non-vascular, VRF, and stroke groups. Prevalence of depression was 51% greater in pts with ≥ 2 VRF (excluding stroke) compared to those with one. |
| Mast, Yochim et al., 2004 | Longitudinal (5) | 77† | 72 (8) | 82 | GDS-15 | GDS >5 | ICD-9 diagnosis of HTN, diabetes, atrial fibrillation. High Risk: ≥ 2, Low Risk: ≤ 1 | For the low-performance group on the Mattis Dementia Rating Scale Initiation/Perseveration Subscale at baseline & 18mo, depressive symptoms increased with an increase in vascular risk. Depressive symptoms did not increase with increasing vascular risk in the group with high performance on the DRS-I/P task. Overall, the high-risk vascular group had higher depression scores than low risk group. |
| Mentz et al., 2015 | Cross-sectional (7) | 2,331* | 47-70 | 34 | BDI-II | BDI-II Total Score |
Heart failure | In Black but not White participants, baseline symptoms of depression and worsening of symptoms over time were associated with increased all-cause mortality/hospitalization. |
| Reinlieb et al., 2014 | Cross-sectional (7) | 42* | 62 (9) | 43 | 24-item HDRS | HDRS ≥ 14 | MRI-defined VaDep | Those classified as having VaDep were more likely to be Black, have an earlier age of depression onset, and have psychomotor retardation, and less likely to have a family history of affective illness than the group with non-vascular depression. There were no differences in response rates to antidepressant treatment between groups. |
| Remigio-Baker et al, 2014 | Cross-sectional (7) | 1,944* | 60+ | 16 | CES-D | CES-D ≥ 16 | Visceral adiposity | Higher depressive symptoms were associated with greater visceral adiposity in men but not women. The effect did not differ by race. |
| Rohyans et al., 2009 | Cross-sectional (7) | 150* | 61 (15) | 31 | PHQ-8 | PHQ-8 ≥ 10 | Heart failure severity | Higher depressive symptoms were associated with more severe heart failure, but the effect did not differ by race. |
| Sharma et al., 2009 | Cross-sectional (7) | 134† | 65 (15) | 86 | PHQ-9 | PHQ-9 ≥ 10 | Acute Decompensated Heart Failure (Emergency Room diagnosis) | 45% of pts had elevated depressive symptoms; 60% were functionally impaired. Those with depression had longer hospital stays, more health comorbidities, and were more likely to have severe heart failure compared to those without depression. There were no differences between African Americans and Caribbean Black groups regarding prevalence of depression or quality of life. |
| Sims et al., 2020 | Cross-sectional (7) | 4,806* | 35-84 | 100 | CES-D | Low, medium and high CES-D scores (not defined) | Obesity, HTN prevalence and control, and diabetes prevalence and control | Obesity and HTN predicted higher depressive symptoms in women; diabetes predicted higher depressive symptoms in men. |
| Taylor et al., 2008 | Cross-sectional | 120* | 54 (13) | 100 | CES-D | CES-D Total Score | Blood pressure, body mass index | Higher depressive symptoms were associated with higher systolic and diastolic blood pressure. |
| Waldman et al., 2009 | Cross-sectional | 864* | 62 (n.r.) | 16 | BDI | BDI cutoffs: < 10, 10‘18, and > 18 | Coronary artery disease | Depression prevalence in coronary artery disease patients did not differ by race. |
Note. Study design is based on the analyses that were relevant for this review. In studies where relevant analyses were only performed on a subset of the total sample, the subsample N is reported. n.s. = not significant (p > 0.5), BDI = Beck Depression Inventory, CES-D = Center for Epidemiologic Studies Depression Scale, CIDI Diagnostic Interview for DSM-IV = Composite International Diagnostic Interview for the Diagnostic and Statistical Manual Version IV, CVD = Cardiovascular Disease, DSM-III-R = Diagnostic and Statistical Manual Version III Revised, DSM-IV = Diagnostic and Statistical Manual Version IV, GDS-15= 15-Item Geriatric Depression Scale, GDS-SF = Short Form Geriatric Depression Scale, HDRS = Hamilton Depression Rating Scale, HTN = Hypertension, ICD-9 = International Classification of Diseases, 9th Revision, IL = Interleukins, MDD = Major Depressive Disorder, PHQ = Patient Health Questionnaire, SF-12 = 12-item Short Form Survey, VaDep = Vascular Depression, VRF = Vascular Risk Factor
* =
community sample
† =
inpatient sample