To the Editor: We read with interest the study conducted by Paul G. Surtees, Ph.D., et al., published in the April 2008 issue of the Journal(1). The authors reported that major depression was associated with increased heart disease mortality in nearly 20,000 individuals between the ages of 41 and 80 years who participated in the Norfolk, U.K. cohort of the European Prospective Investigation Into Cancer (EPIC-Norfolk) Study. This finding suggests that depression specifically increases cardiovascular mortality by cardiovascular mechanisms.

However, Dr. Surtees et al. did not report the association between depression and noncardiovascular mortality. Earlier findings from the EPIC-Norfolk study showed that both cardiovascular and noncardiovascular mortality are increased among individuals with poor self-reported mental health (2) and poor sense of coherence (3). When noncardiovascular mortality is also increased among depressed individuals, it is likely that unhealthy behavior and a lifestyle inherent to depression, rather than cardiovascular mechanisms, explain the increased mortality risk associated with depression (4).

1.Surtees PG, Wainwright NW, Luben RN, Wareham NJ, Bingham SA, Khaw KT: Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom Prospective Cohort Study. Am J Psychiatry 2008; 165:515–5232.Myint PK, Luben RN, Surtees PG, Wainwright NW, Welch AA, Bingham SA, Wareham NJ, Smith RD, Harvey IM, Khaw KT: Self-reported mental health-related quality of life and mortality in men and women in the European Prospective Investigation into Cancer (EPIC-Norfolk): a prospective population study. Psychosom Med 2007; 69:410–4143.Surtees P, Wainwright N, Luben R, Khaw KT, Day N: Sense of coherence and mortality in men and women in the EPIC-Norfolk United Kingdom Prospective Cohort Study. Am J Epidemiol 2003; 158:1202–12094.Vinkers DJ, Stek ML, Gussekloo J, van der Mast RC, Westendorp RG: Does depression in old age increase only cardiovascular mortality? the Leiden 85-Plus Study. Int J Geriatr Psychiatry 2004; 19:852–857

References