Now, I could show you in great detail other
medical conditions and forest plots for these other medical conditions.
I'm just going to show you a few to give you a feeling for
why people are more interested in depressive
disorder than they were twenty years ago.
So in our Baltimore ECA follow-up we had 89 new cases of type two diabetes.
That's the analysis that I just showed you, and there were 1,715 at risk.
And the relative risk was 2.2, and I told
you, that relative risk was not quite statistically significant.
That's why it's not in bold.
But we've done the same kind of study for heart attack, cancer,
stroke, arthritis and actually other conditions not shown here on the slide.
And for heart attack, people with a history of depressant disorder
have a raised risk of heart attack, and it's statistically significant.
That's why the 4.5 is bold.
And you can see in our cohort study
there were 1,551 people at risk for a heart
attack and 64 new cases and if you have
a history of depressive disorder you have a 4
and half times the chance of having a heart attack.
For stroke you have two and half times the risk
for having a stroke after an episode of depressive disorder.
Now if you look at the grow for arthritis, that's the bottom row.
That's the one we were certain that we were going to get a positive relationship.
We did not.
This is something called publication bias.
We could never get published the fact that we
did not find a relationship with depression predicting to arthritis.
We were able to publish about cancer. The relative risk for developing cancer.
All types of cancer put together into one category is 1.0.
That means there's no relationship of depression predicting cancer.
It is important to understand that the
different types of cancer have different idealogies and
they might actually relate in different ways to
depressive disorder, but we can't really show that here.
Now, on the right hand side of this table, we might
wonder, well, does type two diabetes, does it predict to depressive disorder?
And you can see that the 71 new cases or the 71 new cases I show
you earlier, that the new cases of depressive
disorder they are at risk for depressed disorder.
Does a history of diabetes predict to onset of depressive disorder?
Well the relative risk is 1.1, not very important even
people with a heart attack its relative risk is 1.7.
Of course, now this is a 12 year relative risk, so we're letting the, the
effects of the heart attack show up even after 12 years in diabetes and so forth.
It seems logical that people would have fright and
sad mood, a reaction, to having a heart attack.
But after
12 years it doesn't really raise the risk for
depressive disorder, and this may be important that the,
with using the diagnostic criteria of depressive disorder not
the sad mood that may happen after a heart attack.
You can see that the relationship of arthritis predicting to depression
is actually very weak, even though arthritis involves lots of pain.
The strongest finding for predicting depressive disorder is connected
to stroke.
And we know from a clinical literature and clinicians will
tell us that people with a stroke, especially if the
stroke was in the left hemisphere of the brain, they
are very likely to have a episode of depressive disorder.
So there's kind of a brainy
connection between stroke and having depressive disorder.
And we've shown this in our population based data in
which were actually asking people about history of stroke and asking
people about history of depressive disorder.
We don't have a measure a clinical measure other
than just the interview with them but we still
get this finding of 8.4 times the risk of
depressive disorder for people with a history of stroke.
So that concludes our brief report of
our effect of depressive disorder on medical conditions.
And this literature has emerged in the past about 20 years, and makes people
understand the importance of depression.
And in fact, we wonder if we
could prevent depressive disorder or treat depressive disorder.
Would we then lower the risk for these important medical conditions?
And there are control trials out, trying to figure that out.
Whether the treatment of depression, the primary disorder, would lower
the risk for a, something like heart attack, the secondary disorder.
In the next section, we'll talk about a
quantitative estimate for the burden of depressive disorder.