By Dr. Liji Thomas, MD Apr 16 2024 Reviewed by Lily Ramsey, LLM

Cardiovascular disease (CVD) is among the leading causes of illness and death in the current age. While CVD has long been linked to the onset of depression, not much is known about whether the spouses of those affected are more likely to become depressed after such events.

A study recently published in JAMA Network Open explored this topic, laying the foundation for future prospective studies in this field.

Study:  Depression Onset After a Spouse’s Cardiovascular Event . Image Credit: Chay_Tee/ Depression and health

Depression has become 65% more prevalent, and it stands as the predominant mental health disorder worldwide, not only diminishing quality of life but also adversely affecting overall health.

Depression is associated with a higher risk of CVD, dementia, poor cognition, and death. How is CVD linked to depression?

CVD and depression are both more common in people who are obese, and both share inflammation in the immune system. When someone suffers a CVD event such as a stroke or a heart attack, the family also suffers from mental stress, anxiety, and even depression.

The current study was designed to explore the association between CVD and depression at the household level. The data came from a national database maintained by the Japan Health Insurance Association (JHIA).

This included about 40% of the Japanese working-age population or 30 million individuals in this age group. What did the study show?

The researchers found that among nearly 278,000 married couples matched for important characteristics, the vast majority (95%) reported a CVD-related event in the male partner. The mean age of the patients was 58 years. Related StoriesStudy confirms the mental health benefits of weight training for older individualsMetabolic markers tied to increased risk of depression and anxiety, study findsChronic low-level inflammation may be a contributor to both depression and heart disease

Those whose spouses had a CVD event were more likely to be diabetic, hypertensive, or depressed compared to the other group. The spousal group had an increased cumulative incidence of depression, between 4% to 5% for males and females, respectively.

For spouses between 20 and 59 years, about 4% of spouses became depressed vs 3% of those aged 60 years or more.

New-onset depression was observed in nearly 2% of individuals. Spousal risk for depression after a CVD was 13% higher than in the group without such an event.

This did not show any change by age, sex, income, or a previous CVD history.

However, depression risk was higher by 13% to 15% after spousal stroke or heart failure, but not after a heart attack.

Other potentially confounding factors included smoking, drinking, exercise, or whether the index patient was using drugs to reduce blood pressure. None of these showed any impact on the risk of depression in the spouse, however.

The researchers also checked for the possible interaction of these results with the spouse's health status.

They examined the body mass index (BMI), blood pressure, cholesterol levels, blood sugar concentrations, and kidney function. They found that the same increased risk was manifested after controlling for these factors.

The study corroborates the depressive effect of a spousal CVD event, which could involve a need to be a caregiver for the sick spouse.

This could mean inevitable lifestyle alterations, lack of other social interactions, sleep disruptions, and lack of exercise. All these are associated with chronic mental stress, which increases with the level and duration of caregiving.

Financial problems due to the forced loss of employment to manage the spouse’s needs, with additional caregiving-related costs, are another source of stress.

Finally, grief at the loss of a spouse or distress related to the stay of the loved one in the intensive care unit may trigger depression. Conclusions

“These findings highlight the importance of preventive care for mental health disorders in individuals whose spouses experience incident CVD.”

By paying attention to possible confounders such as a history of other diseases, individual practice of healthy habits, and physical health parameters, the study fills a knowledge gap and provides stronger evidence.

Community-level and multidisciplinary clinical support systems should be studied as a possible intervention to reduce this risk for spouses of CVD patients through a wide-spectrum preventive care approach. Journal reference:

Komura, T., Tsugawa, Y., and Kondo, N. (2024) Depression onset after a spouse’s cardiovascular event. JAMA Network Open. doi:10.1001/jamanetworkopen.2024.4602.