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How does feeling blue make the heart grow sicker? Examining the role of the metabolic syndrome in the relationship between depression and coronary heart disease
JE Stevenson - 2012 - Abstract: The aim of the present study was to utilize a structural equation modeling (SEM) approach to simultaneously examine the relationship among depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale (CES-D), the ...
The aim of the present study was to utilize a structural equation modeling (SEM) approach to simultaneously examine the relationship among depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale (CES-D), the Metabolic Syndrome (Met S), and coronary artery calcification (CAC). The proposed models were tested using Mplus Version 5.0 statistical software. Whether these variables are associated and, if so, the direction of the causal pathways, as well as underlying pathophysiological mechanisms that may drive the associations, remain obscure. It was hypothesized that the Met S would provide the necessary mechanism to partially explain the association between depressive symptoms and CAC. Analyses were conducted on a sub-sample of participants derived from the Spokane Heart Study (N=424). First, a confirmatory factor analysis (CFA) was conducted on the Met S latent construct before testing the fit of the proposed structural equation models. Two initial models were tested, a saturated and a direct effects model. The global fit indices revealed a less-than-optimal overall fit of the proposed models. These models did not reveal a significant association between total CES-D scores and either the Met S or CAC. However, the Met S was predictive of total CAC scores. Based on the results of these models, a follow-up model was tested to examine the relationship between the Met S and CAC only. The fit indices for this model revealed good overall global fit, as well as a statistically significant association between the Met S and CAC. Next, both exploratory and confirmatory factor analyses were constructed to identify the underlying structure of the CES-D measure. A statistically significant association was identified between the Positive Affect factor (PA) and CAC. Based on the results of the correlation matrix, SEM models were constructed to examine the relationship between the CES-D factors and CAC. These models revealed good overall global fit although none of the individual path coefficients was found to be statistically significant. These results extend prior correlational data that has suggested an association between the Met S and CAC. Further, these results replicate previous factor analyses that have identified a one-factor structure for the Met S and a three-factor structure for the CES-D measure.
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How does feeling blue make the heart grow sicker? Examining the role of the metabolic syndrome in the relationship between depression and coronary heart disease |
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