Association between depressive symptoms and physical function among participants with heart disease in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.
BACKGROUND: Depression and heart disease frequently co-occur in the aging population and are associated with functional decline and poor health outcomes. Understanding how depressive symptoms relate to different aspects of physical function among adults with heart disease may help identify high-risk subgroups. OBJECTIVE: To examine the association of depressive symptoms with self-reported and observed physical function measures among participants with heart disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and assess whether associations differ by sex and race-sex groups. METHODS: We conducted a cross-sectional analysis using data from REGARDS study second in-home visit (2013-2016). Depressive symptoms were measured with the 10-item Center for Epidemiologic Studies Depression scale (CES-D-10), considering scores ≥10 as clinically significant. Physical function measures were instrumental activities of daily living (IADL), activities of daily living (ADL), chair stand time (5 repetitions), and gait speed. Linear regression models estimated associations of depressive symptoms with function, adjusting for sociodemographic, health behavior, antidepressant medications, body mass index, and social support. Effect modification by sex and race-sex group was evaluated. RESULTS: Among 3,055 participants, 11.7% had CES-D-10 ≥10. Compared to CES-D-10 scores <10, CES-D-10 ≥10 was associated with more limitations in IADL (1.84 points; 95% CI 1.62, 2.06), ADL (0.43 points; 95% CI 0.34, 0.52) and slower chair stand time (0.88 second; 95% CI 0.07, 1.69); associations with gait speed were modest (-0.04 meters/second; 95% CI -0.08, - 0.01). Women had a stronger association between CES-D-10 and ADL (0.49 points; 95% CI 0.35, 0.64) than men (0.33 points; 95% CI 0.21, 0.44; p for interaction = 0.01). Interaction between CES-D-10 and race-sex groups was not statistically significant. CONCLUSIONS: Among adults with heart disease, clinically significant depressive symptoms were associated with lower physical function, particularly among women.
