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More severe symptoms of depression increase coronary heart disease mortality

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Dr M Ahto

Correspondence to: Dr M Ahto, Hakatie Health Centre, Hyvattylantie 7, FI-21420 Lieto, Finland;



Does depression increase the risk of death from coronary heart disease?


660 people (57% women) without coronary heart disease (CHD) who were born in 1926 or earlier, and identified through a study of chronic disease epidemiology in the elderly carried out in southwestern Finland from 1990–1991. Presence of CHD was identified through patient history, medical records and ECG. Baseline exclusions: previous myocardial infarction, angina, ischemic change on the ECG, or past coronary artery bypass graft or angioplasty.


Rural Finland; 1990–2002.

Risk factors:

Severity of depression (assessed with Zung Self-rating Depression Scale (ZSDS); range 20–80 points; more severe symptoms of depression classified as ⩾45 points). Multivariable hazards ratios were calculated using Cox proportional hazard regression, accounting for potential predictors …

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  • Notes: Although the paper suggests that 661 people were included in the study, only 660 are detailed as participants. When compared to DSM-III criteria for diagnosing depression in those aged ⩾65, ZSDS score cut off of 44/45 had 72% sensitivity and 83% specificity. There may be inaccuracies in classification of cause of death. Lipid levels, which could have a confounding affect upon mortality in depressed people, were not examined.

  • Source of funding: The Signe and Arne Gyllenberg Foundation, The Academy of Finland.


  • Competing interests: None.

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