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(Stroke. 2009;40:3166.)
© 2009 American Heart Association, Inc.

Original Contributions

Hopelessness, Depressive Symptoms, and Carotid Atherosclerosis in Women

The Study of Women’s Health Across the Nation (SWAN) Heart Study

Mary O. Whipple, BA; Tené T. Lewis, PhD; Kim Sutton-Tyrrell, DrPH; Karen A. Matthews, PhD; Emma Barinas-Mitchell, PhD; Lynda H. Powell, PhD Susan A. Everson-Rose, PhD, MPH

From Luther College (M.O.W.), Decorah, Iowa; Yale University School of Medicine (T.T.L.), New Haven, Conn; University of Pittsburgh (K.S-T., K.A.M., E.B.-M.), Pittsburgh, Pa; Rush University Medical Center (L.H.P.), Chicago, Ill; and University of Minnesota (S.A.E.-R.), Minneapolis, Minn.

Correspondence to Susan A. Everson-Rose, PhD, MPH, University of Minnesota, Program in Health Disparities Research, 717 Delaware St SE, Room 166, Minneapolis, MN 55414. E-mail saer{at}umn.edu

Background and Purpose— Depression and hopelessness are associated with increased cardiovascular disease (CVD) morbidity and mortality; however, few studies have compared these constructs early in the atherogenic process, particularly in women or minorities.

Methods— This cross-sectional study examined associations of hopelessness and depressive symptoms with carotid artery intimal-medial thickening (IMT) in 559 women (62% white, 38% black; mean±SD age, 50.2±2.8 years) without evidence of clinical CVD from the Study of Women’s Health Across the Nation (SWAN) Heart Study. Hopelessness was measured by 2 questionnaire items; depressive symptoms were measured with the 20-item Center for Epidemiological Studies Depression Scale. Mean and maximum IMT were assessed by B-mode ultrasonography of the carotid arteries.

Results— Increasing hopelessness was significantly related to higher mean (P=0.0139) and maximum (P=0.0297) IMT in regression models adjusted for age, race, site, income, and CVD risk factors. A weaker pattern of associations was noted for depressive symptoms and mean (P=0.1056) and maximum (P=0.0691) IMT. Modeled simultaneously in a risk factor-adjusted model, hopelessness was related to greater mean IMT (P=0.0217) and maximum IMT (P=0.0409), but depressive symptoms were unrelated to either outcome (P>0.4). No interactions with race or synergistic effects of depressive symptoms and hopelessness were observed.

Conclusions— Among middle-aged women, higher levels of hopelessness are associated with greater subclinical atherosclerosis independent of age, race, income, CVD risk factors, and depressive symptoms.

Key Words: atherosclerosis • carotid intimal medial thickness • depression • women