Depressive symptom presentation and course, cardiovascular events and mortality in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

The candidate’s long-term goal is to become an independent investigator examining how psychosocial factors, in particular depressive symptoms, impact cardiovascular health among vulnerable populations. The proposed supplement will provide a specialized 2-year training plan that will enable the candidate to develop expertise in the psychosocial determinants of cardiovascular health, advanced longitudinal data analysis, and grant writing. The mentoring team will ensure a seamlessly transition into independence following completion of the supplement and the research plan will enhance the candidate’s research capabilities. Depressive symptoms are well-established predictors of CVD. However, most studies assess depressive symptoms at a single timepoint, an approach that neglects to account for the dynamic nature of depression. The few studies that include repeated measures, typically use conventional modeling approaches which assume individuals within a population have a single trajectory that can adequately capture average change across all individuals. These approaches can lead to errors because the course of depressive symptoms over the lifetime is highly heterogeneous. This supplement aims to (1) provide a comprehensive characterization of distinct depressive symptom trajectories over a 15-year period and examine their association with CVD outcomes in the Coronary Artery Risk Development in Young Adults (CARDIA) study. In addition, we aim to (2) identify subgroups of depressed individuals based on their symptom presentation, examine whether socio-demographic characteristics and traditional CVD risk factors are associated with distinct depressive symptom subgroups; and assess the stability of depressive symptom subgroups over a 25-year period. Identifying subpopulations of depressed individuals at the greatest risk may elucidate underlying mechanistic pathways and enable better targeting of prevention and treatment efforts.