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Somatic versus cognitive depressive symptoms as predictors of coronary artery disease among women with suspected ischemia: The women's ischemia syndrome evaluation
Ashley S Emami1, C Noel Bairey Merz2, Jo-Ann Eastwood3, Carl J Pepine4, Eileen M Handberg4, Vera Bittner5, Puja K Mehta6, David S Krantz7, Viola Vaccarino6, Wafia Eteiba8, Carol E Cornell9, Thomas Rutledge10
1 Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
2 Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
3 UCLA School of Nursing, Los Angeles, California, USA
4 Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
5 Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
6 Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
7 Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland, USA
8 Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
9 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
10 Psychology Service, VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California, San Diego, California, USA
Correspondence Address:
Dr. Ashley S Emami
Psychology Service 116B, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego 92161, California
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/hm.hm_34_21
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Background: Depression is an established predictor of coronary artery disease (CAD) progression and mortality. “Somatic” symptoms of depression such as fatigue and sleep impairment overlap with symptoms of CAD and independently predict CAD events. Differentiating between “somatic” and “cognitive” depressive symptoms in at-risk patients may improve our understanding of the relationship between depression and CAD. Methods: The study utilized data from the Women's Ischemia Syndrome Evaluation. Participants (N = 641; mean age = 58.0 [11.4] years) were enrolled to evaluate chest pain or suspected myocardial ischemia. They completed a battery of symptom and psychological questionnaires (including the Beck Depression Inventory [BDI]) at baseline, along with quantitative coronary angiography and other CAD diagnostic procedures. The BDI provided scores for total depression and for cognitive and somatic depressive symptom subscales. Results: Two hundred and fourteen (33.4%) women met criteria for obstructive CAD. Logistic regression models were used to examine relationships between depression symptoms and obstructive CAD. Neither BDI total scores (odds ratio [OR] =1.02, 95% confidence interval [CI], 0.99–1.05, P = 0.053) nor BDI cognitive scores (OR = 1.02, 95% CI, 1.00–1.04, P = 0.15) predicted CAD status. BDI somatic symptom scores, however, significantly predicted CAD status and remained statistically significant after controlling for age, race, and education (OR = 1.06, 95% CI, 1.01–1.12, P = 0.02). Conclusion: Among women with suspected myocardial ischemia, somatic but not cognitive depressive symptoms predicted an increased risk of obstructive CAD determined by coronary angiography. Consistent with prior reports, these results suggest a focus on somatic rather than cognitive depressive symptoms could offer additional diagnostic information.
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