Relationship between depression and cerebrovascular disease: conceptual issues

Objectives: The association between cerebrovascular disease (CVD) and depression has been well described, but our understanding of various aspects of the relationship between these two disorders remains limited. Method: Based on a selective literature review, this paper examines empirical evidence and discusses conceptual issues concerning hierarchical, interactive, and co-morbid relationships between CVD and depression. Results: The concept of vascular depression minimizes the importance of the contribution of psychosocial factors. The interactive and co-morbid relationships have been largely neglected in psychiatric research. There is evidence that depression may increase the risk of CVD morbidity in patients with vascular disease and delay recovery in stroke patients, implying an interactive relationship. The concurrent existence of these two disorders based on common etiological factors such as genetic vulnerability, alcoholism and personality traits seems plausible. Conclusions: A modified comorbidity model may guide investigation into the hierarchical, interactive and common etiological relationships between CVD and depression.