The addition of depression to the Framingham Risk Equation model for predicting coronary heart disease risk in women

O'Neil, Adrienne, Fisher, Aaron J., Kibbey, Katherine J., Jacka, Felice N., Kotowicz, Mark A., Williams, Lana J., Stuart, Amanda L., Berk, Michael, Lewandowski, Paul A., Atherton, John J., Taylor, Craig B. and Pasco, Julie A. (2016) The addition of depression to the Framingham Risk Equation model for predicting coronary heart disease risk in women. Preventive Medicine, 87 115-120. doi:10.1016/j.ypmed.2016.02.028

Author O'Neil, Adrienne
Fisher, Aaron J.
Kibbey, Katherine J.
Jacka, Felice N.
Kotowicz, Mark A.
Williams, Lana J.
Stuart, Amanda L.
Berk, Michael
Lewandowski, Paul A.
Atherton, John J.
Taylor, Craig B.
Pasco, Julie A.
Title The addition of depression to the Framingham Risk Equation model for predicting coronary heart disease risk in women
Journal name Preventive Medicine   Check publisher's open access policy
ISSN 1096-0260
Publication date 2016-06-01
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.ypmed.2016.02.028
Open Access Status Not Open Access
Volume 87
Start page 115
End page 120
Total pages 6
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Collection year 2017
Language eng
Formatted abstract

Depression is widely considered to be an independent and robust predictor of Coronary Heart Disease (CHD), however is seldom considered in the context of formal risk assessment. We assessed whether the addition of depression to the Framingham Risk Equation (FRE) improved accuracy for predicting 10-year CHD in a sample of women.


A prospective, longitudinal design comprising an age-stratified, population-based sample of Australian women collected between 1993 and 2011 (n = 862).


Clinical depressive disorder was assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-I/NP), using retrospective age-of-onset data. A composite measure of CHD included non-fatal myocardial infarction, unstable angina coronary intervention or cardiac death. Cox proportional-hazards regression models were conducted and overall accuracy assessed using area under receiver operating characteristic (ROC) curve analysis.


ROC curve analyses revealed that the addition of baseline depression status to the FRE model improved its overall accuracy (AUC:0.77, Specificity:0.70, Sensitivity:0.75) when compared to the original FRE model (AUC:0.75, Specificity:0.73, Sensitivity:0.67). However, when calibrated against the original model, the predicted number of events generated by the augmented version marginally over-estimated the true number observed.


The addition of a depression variable to the FRE equation improves the overall accuracy of the model for predicting 10-year CHD events in women, however may over-estimate the number of events that actually occur. This model now requires validation in larger samples as it could form a new CHD risk equation for women.
Keyword Depression
Coronary heart disease
Risk factor assessment
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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