BrooklynDodger is exploring the link between stress and health. If employment related stress causes depression, and depression causes ill health, then job stress causes ill health. The conclusion requires connecting three dots. Depression has causes other than job stress, increases in job stress may explain only a minority of the variation in depression in the population. It shouldn't be necessary to demonstrate the ultimate health endpoint in a particular study, only the intermediate effect.
In this study, the measure of ill health was dying, specifically from stroke.
The MRFIT project (multiple risk factor intervention and treatment) was one of the those grand and canonical prospective studies of which occupational health researchers can only dream. Probably a hundred papers have come from this data base, which is still being mined.
This study followed people after they exited the trail, correlating later results with the extensive earlier data collected. Changes in these parameters were not measured in the follow up period. It may be that depression at baseline was completely independent of changes in other risk factors (smoking, likely adverse, or alcohol, likely protective) or maybe depressive symptoms drove the other risk factors which in turn drove stroke mortality.
"Men who had completed the Center for Epidemiologic Studies Depression (CES-D) scale (n=11 216) were followed for 18-years... Greater depressive symptoms were associated with significantly higher risk of all-cause mortality and for cause-specific death, a higher risk of CVD, and, more specifically, stroke mortality but not CHD mortality. The significant associations were strongest for those reporting the greatest depression for all-cause mortality,...CVD mortality ... ...stroke mortality ... compared with those in the lowest quintile. These associations were adjusted for age, intervention group, race, educational attainment, smoking at baseline and visit 6, trial averaged systolic blood pressure, alcohol consumption, and fasting cholesterol, as well as the occurrence of nonfatal cardiovascular events during the trial."
(Stroke. 2005;36:98.)© 2005 American Heart Association, Inc.
Depressive Symptoms and Mortality in Men Results From the Multiple Risk Factor Intervention Trial
Brooks B. Gump, PhD, MPH; Karen A. Matthews, PhD; Lynn E. Eberly, PhD; Yue-fang Chang, PhD for the MRFIT Research Group From the Department of Psychology (B.B.G.), State University of New York at Oswego, NY; the Department of Psychiatry (K.M.), University of Pittsburgh, Penn; the Division of Biostatistics (L.E.E.), School of Public Health, University of Minnesota, Minneapolis; and the Department of Epidemiology (Y.C.), University of Pittsburgh, Penn. Correspondence to Dr Brooks B. Gump, Department of Psychology, State University of New York at Oswego, Oswego, NY 13126. E-mail gump@oswego.edu
Background and Purpose— Depression may be a risk factor for cardiovascular disease (CVD) mortality. We evaluated long-term mortality risk associated with depressive symptoms measured at middle age among men at high risk for coronary heart disease (CHD).
Methods— 12 866 men without definite evidence of CHD at study entry but who had above average risk of CHD based on blood pressure, blood cholesterol levels, and/or cigarette smoking were recruited into the Multiple Risk Factor Intervention Trial (MRFIT). Survivors at the end of the trial were followed-up for mortality for an additional 18 years. Men who had completed the Center for Epidemiologic Studies Depression (CES-D) scale near the end of the trial (n=11 216) were used in a prospective analysis of post-trial all-cause and cause-specific mortality during 18-year follow-up after CES-D assessment.
Results— Greater depressive symptoms measured at the end of the trial were associated with significantly higher risk of all-cause mortality and for cause-specific death, a higher risk of CVD, and, more specifically, stroke mortality (all P values <0.02) p="0.48)" hr="1.21" hr="2.03">
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