Browsing by Author "Stewart, Jesse C"

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    Depressive Symptoms are Associated with Poor Adherence to Some Lifestyle but not Medication Recommendations to Prevent Cardiovascular Disease: National Health and Nutrition Examination Survey (NHANES) 2005-2010
    (Office of the Vice Chancellor for Research, 2013-04-05) Berntson, Jessica; Stewart, Kendra Ray; Vrany, Elizabeth; Khambaty, Tasneem; Stewart, Jesse C
    Depression has been linked to poor medical adherence; however, most studies have involved persons with preexisting conditions, such as cardiovascular disease (CVD). Our aim was to examine relationships between depressive symptoms and adherence to medication and lifestyle recommendations intended to prevent CVD in a community sample. We selected adults ≥18 years (53%-56% female, 47%-52% non-white) with a history of hypertension and/or hypercholesterolemia, but free of CVD, who participated in 2005-2010 waves of NHANES – a survey of a large probability sample representative of the U.S. population. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms (converted to z-scores). The NHANES Blood Pressure and Cholesterol questionnaire was used to assess self-reported adherence to five medication and lifestyle recommendations: take antihypertensive medication (N=3313), take lipid-lowering medication (N=2266), control/lose weight (N=2177), eat fewer high fat/cholesterol foods (N=2924), and increase physical activity (N=2540). Logistic regression models (adjusting for age, sex, race-ethnicity, education, body mass, diabetes, smoking status, daily alcohol intake and NHANES sample design) revealed that a 1-SD increase in PHQ-9 total score was associated with a 14% lower likelihood of adherence to the control/lose weight recommendation (OR=0.86, 95% CI: 0.75-0.98, p=.02) and a 25% lower likelihood of adherence to the increase physical activity recommendation (OR=0.75, 95% CI: 0.65-0.86, p<.001). PHQ-9 total score was not associated with the likelihood of adherence to antihypertensive medication (OR, 0.93, 95% CI: 0.82-1.05, p=0.21), lipid-lowering medication (OR=0.99, 95% CI: 0.86-1.14, p=0.90), or eat fewer high fat/cholesterol foods recommendations (OR=0.94, 95% CI: 0.82-1.08, p=0.40). Adherence rates for depressed verses nondepressed adults to the control/lose weight recommendation were 75% and 85% and the increase physical activity recommendation were 63% and 79%, respectively. Our findings suggest that poor adherence to weight and activity recommendations, but not medication and diet recommendations, may partially explain the excess CVD risk of depressed persons.
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    Double Depression is Associated with Greater Risk of Incident Cardiovascular Disease than Major Depression: Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
    (Office of the Vice Chancellor for Research, 2013-04-05) Case, Stephanie M; Sawhney, Manisha; Stewart, Jesse C
    Evidence suggests depressive disorders are risk factors for cardiovascular disease (CVD), however, little attention has been given to double depression (major depressive disorder (MDD) superimposed on dysthymia). The current study sought to determine if double depression is a stronger predictor of incident CVD due to greater duration of exposure and severity of depression in adults initially free of CVD. We analyzed data from 29,581 adults (mean age = 45 years, 58% female, 42% non-white) from Waves 1 (2001-2002) and 2 (2004-2005) of the NESARC study. At Wave 1, the Alcohol Use Disorder and Associated Disabilities Interview Schedule was administered to assess lifetime history of DSM-IV MDD and/or dysthymia. A 4-level variable was created for depression: no depression history (n=24,339), lifetime MDD only (n=4,028), lifetime dysthymia only (n=246), lifetime MDD and dysthymia (double depression; n=968). At Wave 2, participants who reported being diagnosed with myocardial infarction, stroke, angina, or arteriosclerosis in the past year were coded as having incident CVD; those diagnosed with myocardial infarction or stroke were coded as having had a hard CVD event. There were 1,380 CVD events and 365 hard CVD events. Logistic regression models adjusted for demographics (age, sex, race-ethnicity, education) and CVD risk factors (hypertension, hypercholesterolemia, diabetes, smoking, BMI) revealed that lifetime double depression (OR=1.72, 95% CI: 1.31-2.25, p<.001) and MDD only (OR=1.26, 95% CI: 1.06-1.49, p=.01), but not dysthymia only (OR=1.45, 95%, CI: 0.88-2.40, p=.15), predicted incident CVD. Double depression was a stronger predictor than MDD only (p=.04). In models predicting hard CVD events, double depression remained a predictor (OR=1.86, 95% CI: 1.10-3.16, p=.02) but MDD and dysthymia only did not (both ps>.43). Our findings partially support our hypothesis and suggest that persons with double depression may have a stronger connection to an elevated CVD risk in which prevention efforts should be intensified.
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    Effects of Internet Cognitive-Behavioral Therapy on Depressive Symptoms and Surrogates of Cardiovascular Risk in Human Immunodeficiency Virus: A Pilot, Randomized, Controlled Trial
    (Oxford, 2020-07-07) Gupta, Samir K; Slaven, James E; Liu, Ziyue; Polanka, Brittanny M; Freiberg, Matthew S; Stewart, Jesse C; Medicine, School of Medicine
    Background Depression is associated with an increased risk of cardiovascular disease in human immunodeficiency virus (HIV). We hypothesized that reducing depressive symptoms would improve HIV-related cardiovascular risk. Methods We conducted a single-center, randomized (1:1), controlled, parallel-group, assessor-blinded, pilot trial comparing Beating the Blues US (BtB)—an evidence-based, 8-session, internet cognitive-behavioral therapy for depression—with usual care (UC) in HIV-positive participants receiving virologically suppressive antiretroviral therapy and with Patient Health Questionnaire (PHQ)-9 scores ≥10. The primary endpoint was change in brachial artery flow-mediated dilation (FMD) at 12 weeks. Secondary endpoints were FMD change at 24 weeks and inflammation, coagulation, and metabolic biomarker changes at 12 and 24 weeks. Results Fifty-four participants were randomized (27 in each arm). Mean reductions in PHQ-9 scores were significantly greater with BtB versus UC at 12 weeks (−5.60 vs −1.52; P = .007) and 24 weeks (−6.00 vs −1.38; P = .008); reductions in the Hopkins Symptom Checklist Depression Scale-20 scores were also significantly greater with BtB versus UC at 24 weeks (−0.72 vs −0.35; P = .029). Changes in FMD between arms were not significantly different at 12 or 24 weeks. Significantly larger reductions in soluble (s)CD14 and sCD163 with BtB versus UC were found at 12 and 24 weeks, respectively. Conclusions Compared with UC, internet cognitive-behavioral therapy using BtB resulted in greater improvements in depressive symptoms and monocyte activation markers but did not improve FMD in this pilot trial. These data support performing larger studies to determine the potential salutatory effects of behavioral therapies for depression on HIV-related inflammation.
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    Somatic Symptoms, but Not Nonsomatic Symptoms, of Depression are Associated with Insulin Resistance: National Health and Nutrition Examination Survey (NHANES) 2005-2010
    (Office of the Vice Chancellor for Research, 2013-04-05) Vrany, Elizabeth; Berntson, Jessica; Khambaty, Tasneem; Stewart, Jesse C
    While there is a well-established link between depression and type 2 diabetes, depressive symptoms have received little attention in this literature. To begin to address this gap, we examined relationships among the somatic and nonsomatic symptoms of depression and insulin resistance, which is involved in the development of type 2 diabetes. Participants were 4,834 adults (mean age = 44.3 years, 50% female, 19% African American, 20% Mexican American) who participated in the 2005-2010 waves of NHANES – a survey of a large representative sample of the U.S. population. Participants with the following conditions were excluded: diabetes, cardiovascular disease, liver disease, kidney disease, or pregnancy. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), and somatic and nonsomatic subscales were derived based on confirmatory factor analysis. Our index of insulin resistance was the homeostatic model assessment (HOMA) score, which we computed from fasting plasma glucose and insulin levels. Separate regression analyses (adjusted for age, sex, race-ethnicity, education, BMI, and NHANES sample design) demonstrated positive relationships between PHQ-9 total (B=0.04, SEB=0.01, p<0.0001), somatic (B=0.07, SEB=0.02, p=0.0004), and nonsomatic (B=0.06, SEB=0.02, p=0.0004) scores and HOMA score. When the subscales were entered simultaneously into a regression model, the somatic score (B=0.05, SEB=0.02, p=0.03), but not the nonsomatic score (B=0.03, SEB=0.02, p=0.06), remained associated with HOMA score. A significant interaction was found for race-ethnicity, and further analyses demonstrate that the somatic symptoms of depression are only significantly associated with HOMA among Caucasians (B=0.07, SEB=0.02, p=0.02). Our cross-sectional findings suggest that the relationship between depression and insulin resistance may be driven by the somatic symptoms of depression and that this relationship may only be present only occur in Caucasians. The findings suggest that Caucasian adults with the somatic symptoms of depression may be at an elevated risk of type 2 diabetes.
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    Somatic-Vegetative Symptoms of Depression Predict 6-Year Increases in Insulin Resistance: Data from the Pittsburgh Healthy Heart Project
    (Office of the Vice Chancellor for Research, 2013-04-05) Khambaty, Tasneem; Stewart, Jesse C; Muldoon, Matthew F; Kamarck, Thomas W
    Although prospective studies suggest a bidirectional association between depression and type 2 diabetes, few studies have examined depressive symptom clusters or concurrently evaluated both directions of this relationship. Consequently, our objective was to examine the longitudinal, bidirectional associations between the somatic-vegetative and cognitive-affective clusters of depressive symptoms and insulin resistance, which is implicated in the pathophysiology of type 2 diabetes. Participants were 269 adults (baseline age range: 50-70 years, 55% female, 14% non-white) without diabetes enrolled in the Pittsburgh Healthy Heart Project, a prospective cohort study. At baseline and the 6-year visits, participants completed the Beck Depression Inventory-II (BDI-II) to assess depressive symptoms and underwent a blood draw to quantify fasting serum insulin and glucose. We examined baseline BDI-II total and subscale scores as predictors of 6-year change in the homeostatic model assessment (HOMA) score, an index of insulin resistance computed from fasting insulin and glucose. We also examined baseline HOMA score as a predictor of 6-year change in BDI-II total and subscale scores. HOMA and BDI-II change were computed as follow-up score minus baseline score. Regression analyses, adjusted for baseline HOMA score and demographic factors, revealed that the baseline BDI-II somatic-vegetative score (beta=.14, p=.03), but not the total (beta=.10, p=.11) or cognitive-affective (beta=.004, p=.95) scores, was a predictor of 6-year increases in the HOMA score. The pattern of results was similar after further adjustment for body mass index, except that the BDI-II total score became a predictor of HOMA change (beta=.13, p=.03). In contrast, the baseline HOMA score did not predict 6-year change in BDI-II total, somatic-vegetative, or cognitive-affective scores (all p’s>.48). Our findings indicate that older adults experiencing the somatic-vegetative symptoms of depression (e.g., fatigue, sleep disturbance, and appetite changes) may be at an increased risk of insulin resistance and subsequent type 2 diabetes.