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

doi:10.1037/hea0000316

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

School of Medicine

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

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 language	English (US)
Pages (from-to)	614-624
Number of pages	11
Journal	Health Psychology
Volume	35
Issue number	6
DOIs	https://doi.org/10.1037/hea0000316
State	Published - Jun 1 2016

Keywords

Bifactor model
Depression
Medical prognosis
Myocardial infarction

ASJC Scopus subject areas

Applied Psychology
Psychiatry and Mental health

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10.1037/hea0000316

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@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}",

note = "Publisher Copyright: {\textcopyright} 2016 American Psychological Association.",

year = "2016",

month = jun,

day = "1",

doi = "10.1037/hea0000316",

language = "English (US)",

volume = "35",

pages = "614--624",

journal = "Health Psychology",

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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

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

Abstract

Keywords

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