Original Contributions Hopelessness, Depressive Symptoms, and Carotid Atherosclerosis in Women The Study of Women’s Health Across the Nation (SWAN) Heart Study

Background and Purpose—Depression and hopelessness are associated with increased cardiovascular disease (CVD) morbidity and mortality; however, few studies have compared these constructs early in the atherogenic process, particularly in women or minorities. Methods—This cross-sectional study examined associations of hopelessness and depressive symptoms with carotid artery intimal-medial thickening (IMT) in 559 women (62% white, 38% black; mean SD age, 50.2 2.8 years) without evidence of clinical CVD from the Study of Women’s Health Across the Nation (SWAN) Heart Study. Hopelessness was measured by 2 questionnaire items; depressive symptoms were measured with the 20-item Center for Epidemiological Studies Depression Scale. Mean and maximum IMT were assessed by B-mode ultrasonography of the carotid arteries. Results—Increasing hopelessness was significantly related to higher mean (P 0.0139) and maximum (P 0.0297) IMT in regression models adjusted for age, race, site, income, and CVD risk factors. A weaker pattern of associations was noted for depressive symptoms and mean (P 0.1056) and maximum (P 0.0691) IMT. Modeled simultaneously in a risk factor–adjusted model, hopelessness was related to greater mean IMT (P 0.0217) and maximum IMT (P 0.0409), but depressive symptoms were unrelated to either outcome (P 0.4). No interactions with race or synergistic effects of depressive symptoms and hopelessness were observed. Conclusions—Among middle-aged women, higher levels of hopelessness are associated with greater subclinical atherosclerosis independent of age, race, income, CVD risk factors, and depressive symptoms. (Stroke. 2009;40:3166-3172.)