A bifactor model of the Beck's Depression Inventory and its association with medical prognosis in patients with myocardial infarction

An individual patients data meta analysis of 13100 patients

R. de Miranda Azevedo, A.M. Roest, R.M. Carney, J. Denollet, K.E. Freedland, S.L. Grace, S.H. Hosseini, D.A. Lane, K. Parakh, L. Pilote, P. de Jonge

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objectives: 
Evidence suggests that depression is associated with adverse outcomes in patients with myocardial infarction (MI). Some of the symptoms of depression may also be symptoms of somatic illness and these may confound the association between depression and prognosis. We investigated whether depression following MI is associated with medical prognosis independent of these somatic symptoms. 
Method: 
The database of an individual patient data meta-analysis was used. Endpoints were all-cause mortality and cardiovascular events. Nine studies were included. Bifactor factor analysis included 13,100 participants and 7,595 participants were included in survival models. Dimensions were generated from the Beck Depression Inventory using factor analyses. The prognostic association was assessed using mixed-effects Cox regression analysis. 
Results: 
A bifactor model, consisting of a general factor and 2 general depression-free subgroup factors (a somatic/affective and a cognitive/affective), provided the best fit. There was a significant association between the general depression factor and all-cause mortality (hazard ratio [HR] = 1.25; 95% confidence interval [CI] [1.17, 1.34], p < .001) and cardiovascular events (HR = 1.18; 95% CI [1.13, 1.23], p < .001). After adjustment for demographics, measures of cardiac disease severity, and health-related variables, the association between the general depression factor and all-cause mortality (HR = 1.14; 95% CI [1.04, 1.25], p = .003) and cardiovascular events (HR = 1.16; 95% CI [1.10, 1.23], p = .014) attenuated. Additionally, the general depression-free somatic/affective factor was significantly associated with the endpoints, while the general depression-free cognitive/affective was not. 
Conclusions: 
A general depression factor is associated with adverse medical prognosis following MI independent of somatic/affective symptoms that may be partly attributable to somatic illness.
Original languageEnglish
Pages (from-to)614-624
JournalHealth Psychology
Volume35
Issue number6
DOIs
Publication statusPublished - 2016

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Depression
Equipment and Supplies
Confidence Intervals
Statistical Factor Analysis
Affective Symptoms
Databases
Medically Unexplained Symptoms

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de Miranda Azevedo, R. ; Roest, A.M. ; Carney, R.M. ; Denollet, J. ; Freedland, K.E. ; Grace, S.L. ; Hosseini, S.H. ; Lane, D.A. ; Parakh, K. ; Pilote, L. ; de Jonge, P. / A bifactor model of the Beck's Depression Inventory and its association with medical prognosis in patients with myocardial infarction : An individual patients data meta analysis of 13100 patients. In: Health Psychology. 2016 ; Vol. 35, No. 6. pp. 614-624.
@article{bf2d0fee099f4519b15d94f9630413a7,
title = "A bifactor model of the Beck's Depression Inventory and its association with medical prognosis in patients with myocardial infarction: An individual patients data meta analysis of 13100 patients",
abstract = "Objectives: Evidence suggests that depression is associated with adverse outcomes in patients with myocardial infarction (MI). Some of the symptoms of depression may also be symptoms of somatic illness and these may confound the association between depression and prognosis. We investigated whether depression following MI is associated with medical prognosis independent of these somatic symptoms. Method: The database of an individual patient data meta-analysis was used. Endpoints were all-cause mortality and cardiovascular events. Nine studies were included. Bifactor factor analysis included 13,100 participants and 7,595 participants were included in survival models. Dimensions were generated from the Beck Depression Inventory using factor analyses. The prognostic association was assessed using mixed-effects Cox regression analysis. Results: A bifactor model, consisting of a general factor and 2 general depression-free subgroup factors (a somatic/affective and a cognitive/affective), provided the best fit. There was a significant association between the general depression factor and all-cause mortality (hazard ratio [HR] = 1.25; 95{\%} confidence interval [CI] [1.17, 1.34], p < .001) and cardiovascular events (HR = 1.18; 95{\%} CI [1.13, 1.23], p < .001). After adjustment for demographics, measures of cardiac disease severity, and health-related variables, the association between the general depression factor and all-cause mortality (HR = 1.14; 95{\%} CI [1.04, 1.25], p = .003) and cardiovascular events (HR = 1.16; 95{\%} CI [1.10, 1.23], p = .014) attenuated. Additionally, the general depression-free somatic/affective factor was significantly associated with the endpoints, while the general depression-free cognitive/affective was not. Conclusions: A general depression factor is associated with adverse medical prognosis following MI independent of somatic/affective symptoms that may be partly attributable to somatic illness.",
author = "{de Miranda Azevedo}, R. and A.M. Roest and R.M. Carney and J. Denollet and K.E. Freedland and S.L. Grace and S.H. Hosseini and D.A. Lane and K. Parakh and L. Pilote and {de Jonge}, P.",
year = "2016",
doi = "10.1037/hea0000316",
language = "English",
volume = "35",
pages = "614--624",
journal = "Health Psychology",
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de Miranda Azevedo, R, Roest, AM, Carney, RM, Denollet, J, Freedland, KE, Grace, SL, Hosseini, SH, Lane, DA, Parakh, K, Pilote, L & de Jonge, P 2016, 'A bifactor model of the Beck's Depression Inventory and its association with medical prognosis in patients with myocardial infarction: An individual patients data meta analysis of 13100 patients', Health Psychology, vol. 35, no. 6, pp. 614-624. https://doi.org/10.1037/hea0000316

A bifactor model of the Beck's Depression Inventory and its association with medical prognosis in patients with myocardial infarction : An individual patients data meta analysis of 13100 patients. / de Miranda Azevedo, R.; Roest, A.M.; Carney, R.M.; Denollet, J.; Freedland, K.E.; Grace, S.L.; Hosseini, S.H.; Lane, D.A.; Parakh, K.; Pilote, L.; de Jonge, P.

In: Health Psychology, Vol. 35, No. 6, 2016, p. 614-624.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - A bifactor model of the Beck's Depression Inventory and its association with medical prognosis in patients with myocardial infarction

T2 - An individual patients data meta analysis of 13100 patients

AU - de Miranda Azevedo, R.

AU - Roest, A.M.

AU - Carney, R.M.

AU - Denollet, J.

AU - Freedland, K.E.

AU - Grace, S.L.

AU - Hosseini, S.H.

AU - Lane, D.A.

AU - Parakh, K.

AU - Pilote, L.

AU - de Jonge, P.

PY - 2016

Y1 - 2016

N2 - Objectives: Evidence suggests that depression is associated with adverse outcomes in patients with myocardial infarction (MI). Some of the symptoms of depression may also be symptoms of somatic illness and these may confound the association between depression and prognosis. We investigated whether depression following MI is associated with medical prognosis independent of these somatic symptoms. Method: The database of an individual patient data meta-analysis was used. Endpoints were all-cause mortality and cardiovascular events. Nine studies were included. Bifactor factor analysis included 13,100 participants and 7,595 participants were included in survival models. Dimensions were generated from the Beck Depression Inventory using factor analyses. The prognostic association was assessed using mixed-effects Cox regression analysis. Results: A bifactor model, consisting of a general factor and 2 general depression-free subgroup factors (a somatic/affective and a cognitive/affective), provided the best fit. There was a significant association between the general depression factor and all-cause mortality (hazard ratio [HR] = 1.25; 95% confidence interval [CI] [1.17, 1.34], p < .001) and cardiovascular events (HR = 1.18; 95% CI [1.13, 1.23], p < .001). After adjustment for demographics, measures of cardiac disease severity, and health-related variables, the association between the general depression factor and all-cause mortality (HR = 1.14; 95% CI [1.04, 1.25], p = .003) and cardiovascular events (HR = 1.16; 95% CI [1.10, 1.23], p = .014) attenuated. Additionally, the general depression-free somatic/affective factor was significantly associated with the endpoints, while the general depression-free cognitive/affective was not. Conclusions: A general depression factor is associated with adverse medical prognosis following MI independent of somatic/affective symptoms that may be partly attributable to somatic illness.

AB - Objectives: Evidence suggests that depression is associated with adverse outcomes in patients with myocardial infarction (MI). Some of the symptoms of depression may also be symptoms of somatic illness and these may confound the association between depression and prognosis. We investigated whether depression following MI is associated with medical prognosis independent of these somatic symptoms. Method: The database of an individual patient data meta-analysis was used. Endpoints were all-cause mortality and cardiovascular events. Nine studies were included. Bifactor factor analysis included 13,100 participants and 7,595 participants were included in survival models. Dimensions were generated from the Beck Depression Inventory using factor analyses. The prognostic association was assessed using mixed-effects Cox regression analysis. Results: A bifactor model, consisting of a general factor and 2 general depression-free subgroup factors (a somatic/affective and a cognitive/affective), provided the best fit. There was a significant association between the general depression factor and all-cause mortality (hazard ratio [HR] = 1.25; 95% confidence interval [CI] [1.17, 1.34], p < .001) and cardiovascular events (HR = 1.18; 95% CI [1.13, 1.23], p < .001). After adjustment for demographics, measures of cardiac disease severity, and health-related variables, the association between the general depression factor and all-cause mortality (HR = 1.14; 95% CI [1.04, 1.25], p = .003) and cardiovascular events (HR = 1.16; 95% CI [1.10, 1.23], p = .014) attenuated. Additionally, the general depression-free somatic/affective factor was significantly associated with the endpoints, while the general depression-free cognitive/affective was not. Conclusions: A general depression factor is associated with adverse medical prognosis following MI independent of somatic/affective symptoms that may be partly attributable to somatic illness.

U2 - 10.1037/hea0000316

DO - 10.1037/hea0000316

M3 - Article

VL - 35

SP - 614

EP - 624

JO - Health Psychology

JF - Health Psychology

SN - 0278-6133

IS - 6

ER -