Retinal microvascular function and incidence and trajectories of clinically relevant depressive symptoms: the Maastricht Study

April C E van Gennip, Monideepa D Gupta, Alfons J H M Houben, Tos T J M Berendschot, Carroll A B Webers, Marleen M J van Greevenbroek, Carla J H van der Kallen, Annemarie Koster, Anke Wesselius, Simone J P M Eussen, Casper G Schalkwijk, Bastiaan E de Galan, Sebastian Köhler, Miranda T Schram, Coen D A Stehouwer, Thomas T van Sloten

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Cerebral microvascular dysfunction may contribute to depression via disruption of brain structures involved in mood regulation, but evidence is limited. We investigated the association of retinal microvascular function, a proxy for microvascular function in the brain, with incidence and trajectories of clinically relevant depressive symptoms.

METHODS: Longitudinal data are from The Maastricht Study of 5952 participants (59.9 ± 8.5 years/49.7% women) without clinically relevant depressive symptoms at baseline (2010-2017). Central retinal arteriolar equivalent and central retinal venular equivalent (CRAE and CRVE) and a composite score of flicker light-induced retinal arteriolar and venular dilation were assessed at baseline. We assessed incidence and trajectories of clinically relevant depressive symptoms (9-item Patient Health Questionnaire score ⩾10). Trajectories included continuously low prevalence (low, n = 5225 [87.8%]); early increasing, then chronic high prevalence (early-chronic, n = 157 [2.6%]); low, then increasing prevalence (late-increasing, n = 247 [4.2%]); and remitting prevalence (remitting, n = 323 [5.4%]).

RESULTS: After a median follow-up of 7.0 years (range 1.0-11.0), 806 (13.5%) individuals had incident clinically relevant depressive symptoms. After full adjustment, a larger CRAE and CRVE were each associated with a lower risk of clinically relevant depressive symptoms (hazard ratios [HRs] per standard deviation [s.d.]: 0.89 [95% confidence interval (CI) 0.83-0.96] and 0.93 [0.86-0.99], respectively), while a lower flicker light-induced retinal dilation was associated with a higher risk of clinically relevant depressive symptoms (HR per s.d.: 1.10 [1.01-1.20]). Compared to the low trajectory, a larger CRAE was associated with lower odds of belonging to the early-chronic trajectory (OR: 0.83 [0.69-0.99]) and a lower flicker light-induced retinal dilation was associated with higher odds of belonging to the remitting trajectory (OR: 1.23 [1.07-1.43]).

CONCLUSIONS: These findings support the hypothesis that cerebral microvascular dysfunction contributes to the development of depressive symptoms.

Original languageEnglish
Pages (from-to)2482-2491
Number of pages10
JournalPsychological medicine
Volume54
Issue number10
Early online date12 Mar 2024
DOIs
Publication statusPublished - Jul 2024

Keywords

  • depressive symptoms
  • epidemiology
  • longitudinal study
  • retinal microvascular function
  • trajectories
  • vascular depression

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