A bifactor model of the beck depression inventory and its association with medical prognosis after myocardial infarction

Ricardo de Miranda Azevedo, Annelieke M. Roest, Robert M. Carney, Johan Denollet, Kenneth E. Freedland, Sherry L. Grace, Seyed H. Hosseini, Deirdre A. Lane, Kapil Parakh, Louise Pilote, Peter de Jonge

Research output: Contribution to journalArticle

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 (US)
Pages (from-to)614-624
Number of pages11
JournalHealth Psychology
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Myocardial Infarction
Depression
Equipment and Supplies
Confidence Intervals
Statistical Factor Analysis
Mortality
Affective Symptoms
Meta-Analysis
Heart Diseases
Regression Analysis
Demography
Databases
Survival
Health
Medically Unexplained Symptoms

Keywords

  • Bifactor model
  • Depression
  • Medical prognosis
  • Myocardial infarction

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

Azevedo, R. D. M., Roest, A. M., Carney, R. M., Denollet, J., Freedland, K. E., Grace, S. L., ... Jonge, P. D. (2016). A bifactor model of the beck depression inventory and its association with medical prognosis after myocardial infarction. Health Psychology, 35(6), 614-624. https://doi.org/10.1037/hea0000316

A bifactor model of the beck depression inventory and its association with medical prognosis after myocardial infarction. / Azevedo, Ricardo de Miranda; Roest, Annelieke M.; Carney, Robert M.; Denollet, Johan; Freedland, Kenneth E.; Grace, Sherry L.; Hosseini, Seyed H.; Lane, Deirdre A.; Parakh, Kapil; Pilote, Louise; Jonge, Peter de.

In: Health Psychology, Vol. 35, No. 6, 01.06.2016, p. 614-624.

Research output: Contribution to journalArticle

Azevedo, RDM, Roest, AM, Carney, RM, Denollet, J, Freedland, KE, Grace, SL, Hosseini, SH, Lane, DA, Parakh, K, Pilote, L & Jonge, PD 2016, 'A bifactor model of the beck depression inventory and its association with medical prognosis after myocardial infarction', Health Psychology, vol. 35, no. 6, pp. 614-624. https://doi.org/10.1037/hea0000316
Azevedo, Ricardo de Miranda ; Roest, Annelieke M. ; Carney, Robert M. ; Denollet, Johan ; Freedland, Kenneth E. ; Grace, Sherry L. ; Hosseini, Seyed H. ; Lane, Deirdre A. ; Parakh, Kapil ; Pilote, Louise ; Jonge, Peter de. / A bifactor model of the beck depression inventory and its association with medical prognosis after myocardial infarction. In: Health Psychology. 2016 ; Vol. 35, No. 6. pp. 614-624.
@article{d35b9e856d5e461bb6faed5ba91f3a81,
title = "A bifactor model of the beck depression inventory and its association with medical prognosis after myocardial infarction",
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.",
keywords = "Bifactor model, Depression, Medical prognosis, Myocardial infarction",
author = "Azevedo, {Ricardo de Miranda} and Roest, {Annelieke M.} and Carney, {Robert M.} and Johan Denollet and Freedland, {Kenneth E.} and Grace, {Sherry L.} and Hosseini, {Seyed H.} and Lane, {Deirdre A.} and Kapil Parakh and Louise Pilote and Jonge, {Peter de}",
year = "2016",
month = "6",
day = "1",
doi = "10.1037/hea0000316",
language = "English (US)",
volume = "35",
pages = "614--624",
journal = "Health Psychology",
issn = "0278-6133",
publisher = "American Psychological Association Inc.",
number = "6",

}

TY - JOUR

T1 - A bifactor model of the beck depression inventory and its association with medical prognosis after myocardial infarction

AU - Azevedo, Ricardo de Miranda

AU - Roest, Annelieke M.

AU - Carney, Robert M.

AU - Denollet, Johan

AU - Freedland, Kenneth E.

AU - Grace, Sherry L.

AU - Hosseini, Seyed H.

AU - Lane, Deirdre A.

AU - Parakh, Kapil

AU - Pilote, Louise

AU - Jonge, Peter de

PY - 2016/6/1

Y1 - 2016/6/1

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.

KW - Bifactor model

KW - Depression

KW - Medical prognosis

KW - Myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=84958581167&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958581167&partnerID=8YFLogxK

U2 - 10.1037/hea0000316

DO - 10.1037/hea0000316

M3 - Article

C2 - 26901082

AN - SCOPUS:84958581167

VL - 35

SP - 614

EP - 624

JO - Health Psychology

JF - Health Psychology

SN - 0278-6133

IS - 6

ER -