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Freelancers with depression could be at higher risk of heart and circulatory diseases

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If you manage depression through psychological therapy you could have a better chance of decreasing your risk of heart disease and stroke, according to research

The risk of cardiovascular disease is approximately 72% higher among people with major depressive disorders compared to their healthy peers. This is just one of the statistics that compelled researchers to look into how effective management of depression through psychological therapy could lower the likelihood of heart disease and stroke.

The study, published in European Heart Journal, was the first of its kind to investigate whether reducing depression symptoms with psychological therapy is associated with a lower likelihood of future cardiovascular disease.

The study included 636,955 adults over 45 years old with depression who had completed a course of psychological therapy and did not have cardiovascular disease or dementia.

“Our study suggests that improving mental health could also help physical health, especially in those aged under 60,” said study author Ms. Céline El Baou, a PhD student at University College London, UK.

People whose depression symptoms improved after therapy had a 10% to 15% lower risk of cardiovascular disease than those who did not improve. Comparable effects were found in similar studies investigating low-fat diets.

How is depression assessed?

Depression level was assessed before and after therapy using the Patient Health Questionnaire-9 (PHQ-9) which gives a score of 0 (not at all) to 3 (nearly every day) for nine items including little interest or pleasure in doing things; feeling down, depressed, or hopeless; trouble falling or staying asleep, or sleeping too much; feeling tired or having little energy; poor appetite or overeating; feeling you are a failure or have let yourself or your family down; trouble concentrating on things; moving or speaking slowly or being fidgety or restless; thoughts that you would be better off dead, or of hurting yourself in some way. Depression was defined as a score of 10 or more.

How is improved depression assessed?

The study reported that any improvement in depression was defined as a reduction of 6 points or more in the PHQ-9 score and no worsening of anxiety (defined as an increase of 4 points or more on the Generalized Anxiety Disorder scale) between the start and end of treatment.

Anxiety was included in the definition so that the outcome of therapy was not considered good if depression improved but anxiety worsened, said the study.

Patients were followed for new onset all-cause cardiovascular disease, coronary heart disease, stroke and all-cause mortality.

Follow-up commenced 365 days after the last therapy session and those with a cardiovascular event during this period were excluded to reduce the likelihood that previously undiagnosed disease was the cause of depression.

During a median follow-up of 3.1 years, depression symptoms improved in 373,623 (59%) participants and did not improve in 263,332 (41%). There were 49,803 cardiovascular events and 14,125 participants died.

Improvement of depression was associated with 12%, 11%, 12% and 19% lower risks of any cardiovascular disease, coronary heart disease, stroke and all-cause mortality, respectively, versus no improvement.

Ms. El Baou said: “The findings are consistent with previous research suggesting that interventions to modify risk factors for cardiovascular disease are more effective at a younger age. This highlights the value of receiving help early to gain the most benefit.”

“Our findings emphasise the importance of making psychological treatments more widely available and accessible to enhance mental and physical health. This is especially relevant for certain groups who face barriers to accessing psychological therapies and are at greater risk of cardiovascular disease.

“Collaborative care systems where specialists from both disciplines work together could be one way to make treatment more accessible and obtain better outcomes overall.”

Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation, said of the study:

“This study shows that successful treatment of depression using psychological therapies is associated with lower subsequent risk of heart and circulatory diseases, including heart attacks and strokes.

“While observational, it provides further evidence that brain and heart health are connected and that treating depression may have other significant benefits beyond improving mental health.

“However, more research is needed to demonstrate whether the therapy is actually causing the reduction in heart and circulatory conditions, and if so, how.”

If you are a freelancer who is noticing the signs of depression taking over your daily life, we urge you to get support. There’s only one you in this world and you are worth taking care of.

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