Depression and cardiovascular disease: a complex relationship

See doi:10.1016/j.ehj.2003.08.017 and doi:10.1016/j.ehj.2003.09.003 for the articles to which this editorial refers A large literature attests to the strong relationship between depression and cardiovascular disease. A number of studies have shown an association between depression and coronary mortality raising the obvious question as to whether depression is a causative factor contributing to coronary heart disease, a consequence, or both. This area of study where cardiac and psychosocial scientists have joined only relatively recently is a very difficult one. Nevertheless, modern paradigms for coronary heart disease have certainly now been extended beyond purely biomedical concepts to include the important broader dimensions of psychosocial, and socioeconomic aspects which are of fundamental and increasing importance. Likewise, in many instances recent health strategies have acknowledged the importance of interaction amongst these different aspects through providing a broader definition of health than formerly and emphasising the importance of intersectoral collaboration to achieve population and personal health goals.Firm conclusions from previous psychosocial and cardiac literature have often necessarily been limited by a number of considerations including publication bias, subject selection and response rates. Studies of association, often retrospective, are inevitably highly confounded by the …