The development of depressive symptoms during medical internship stress predicts worsening vascular function

Abstract

Objective: We sought to prospectively determine whether the onset of internship stress and any subsequent depression alters physiological markers of early vascular disease. Methods: We explored potential mechanisms linking stress and depression to vascular disease in a prospective cohort of 37 participants exposed to medical internship stress, an established precipitant of depressive symptomatology. Results: Change in depressive symptom score from baseline over one year of internship stress was inversely correlated with change in the reactive hyperemia index (RHI), a measure of peripheral endothelial function (r= 0.41, p= 0.01). The change in depressive symptoms in the first six months of internship was similarly related to change in RHI over one year (r= 0.38, p= 0.02). While the development of depressive symptoms did not significantly impact changes in endothelial progenitor cells (EPCs), EPCs did significantly decrease with the year of internship stress (11.9 to 3.4. cells/ml blood; p= 0.01). Conclusion: Endothelial function may be a critical link between stress, depression, and cardiovascular disease and a feasible surrogate outcome for prospective studies.