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The CARDIA Study

Mary A. Whooley, MD; Catarina I. Kiefe, MD,PhD; Margaret A. Chesney, PhD; Jerome H. Markovitz, MD; Karen Matthews, PhD; Stephen B. Hulley, MD,MPH

Arch Intern Med. 2002;162:2614-2620.

Background  Previous studies have suggested an association between depression and low socioeconomic status, but few have empirically examined the effect of depressive symptoms on income and employment over time.

Objective  To determine whether depressive symptoms are associated with subsequent unemployment or loss of family income.

Methods  We performed a prospective cohort study of 5115 adults aged 18 to 30 years. These participants included approximately equal numbers of African Americans and whites and men and women from 4 cities in the United States who completed the 1990-1991 examination of the Coronary Artery Risk Development in Young Adults (CARDIA) study. For this analysis, we included 2334 participants who were employed full or part time and who reported an annual family income of $25 000 or more. Participants completed the Center for Epidemiologic Studies Depression Scale and were considered to have depressive symptoms if they scored 16 or higher on the 60-point scale. We evaluated self-reported unemployment and annual family income during 5 years of follow-up.

Results  Thirty-three percent (118/354) of participants with depressive symptoms (Center for Epidemiologic Studies Depression Scale score 16) in 1990-1991 and 21% (335/1581) of participants without substantial depressive symptoms (Center for Epidemiologic Studies Depression Scale score <16) reported new unemployment during the subsequent 5 years (odds ratio, 1.9; 95% confidence interval, 1.4-2.4; P<.001). This association remained strong after adjusting for potential confounding variables, including marital status, education, history of unemployment, current part-time (vs full-time) employment, and cigarette smoking (odds ratio, 1.6; 95% confidence interval, 1.2-2.0; P = .001). Seventeen percent (62/371) of participants with depressive symptoms and 7% (113/1631) of participants without substantial depressive symptoms in 1990-1991 reported that their family income had decreased below $25 000 by 1995-1996 (odds ratio, 2.7; 95% confidence interval, 1.9-3.8; P<.001). This association also remained strong after adjusting for potential confounding variables (odds ratio, 1.9; 95% confidence interval, 1.3-2.7; P<.001).

Conclusions  Depressive symptoms are associated with subsequent unemployment and loss of family income among working young adults. Socioeconomic indicators, such as income and employment, should be considered in evaluating the potential benefits of treatment for patients with depressive symptoms.

From the Department of Veterans Affairs Medical Center (Dr Whooley), and Departments of Medicine (Drs Whooley and Chesney) and Epidemiology and Biostatistics (Drs Whooley and Hulley), University of California, San Francisco; Center for Outcomes and Effectiveness Research and Education (Dr Kiefe), and Division of Preventive Medicine, Department of Medicine (Drs Kiefe and Markovitz), The University of Alabama at Birmingham, and Department of Veterans Affairs Medical Center (Drs Kiefe and Markovitz), Birmingham, Ala; and Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pa (Dr Matthews).
Dr Markovitz died in September 2002.

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