General health status and vascular disorders as correlates of late-life depressive symptoms in a national survey sample Robert Stewart 1 and Vasant Hirani 2 1 King’s College London (Institute of Psychiatry), London, UK 2 Royal Free and University College London Medical School, University College London, London, UK Correspondence to: Dr R. Stewart, E-mail: r.stewart@iop.kcl.ac.uk Objectives: To investigate the associations between vascular disease, vascular risk factors and depressive symptoms in a national survey sample, the extent to which these associations are accounted for by general health status and the extent to which the association between depressive symptoms and worse general health is accounted for by level of vascular risk. Methods: Data were analysed from the Health Survey for England 2005: a nationally representative cross- sectional population survey comprising 4269 adults aged  65 living in private households. Data collected included depressive symptoms (10-item Geriatric Depression Scale), self-reported general health and vascular disease/risk factors, resting blood pressure and lipid profile. Results: Case level depressive symptoms were associated with reported previous stroke, ischaemic heart disease and diabetes, as well as with current smoking. These associations were attenuated substantially when adjusted for general health status. On the other hand, the association between worse subjective health and depressive symptoms was not altered following adjustment for vascular disease/risk status. Conclusion: Worse general health appears to account for a large part of associations between cardio- vascular disorders and depression, although this may represent ‘over-adjustment’. Cardiovascular disease/risk does not appear to account for much of the association between worse general health and depression. Copyright # 2009 John Wiley & Sons, Ltd. Key words: depression; depressive disorder; cardiovascular disease; hypertension; diabetes; cholesterol; smoking; stroke; general health History: Received 8 February 2009; Accepted 22 June 2009; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.2366 Introduction Clinically significant depression is common in later life and associated with substantial distress and disability. It is well-recognised that depression prevalence is increased in people with worse physical health (Berk- man et al., 1986; Prince et al., 1997). However, it has also been suggested that many cases of late-life depression have a cerebrovascular aetiology (Alex- opoulos et al., 1997; Hickie and Scott, 1998), implying that people with existing cerebrovascular disease or higher levels of vascular risk may have a greater than expected risk of depression. Risk of depression has been found to be increased after clinical stroke and in association with coronary artery disease (Pohjasvaara et al., 1998; Lespe ´rance et al., 2002), and late-life depression has been found to be associated with neuroimaging findings suggestive of subclinical cerebrovascular disease (de Groot et al., 2000). Depression is also potentially a risk factor for cardiovascular disease: in prospective studies of younger adults, depressive symptoms have also been found to be associated with increased incidence rates of myocardial infarction and stroke (Ford et al., 1998; Larson et al., 2001), and depression and dysthymia may also be important in the aetiology of vascular risk factors such as hypertension (Levenstein et al., 2001). RESEARCH ARTICLE Copyright # 2009 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry (2009)