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Type: Journal article
Title: Establishing the bidirectional relationship between depression and subclinical arteriosclerosis - rationale, design, and characteristics of the BiDirect Study
Author: Teismann, H.
Wersching, H.
Nagel, M.
Arolt, V.
Heindel, W.
Baune, B.
Wellmann, J.
Hense, H.
Berger, K.
Citation: BMC Psychiatry, 2014; 14(1):174-1-174-9
Publisher: BioMed Central
Issue Date: 2014
ISSN: 1471-244X
Statement of
Henning Teismann, Heike Wersching, Maren Nagel, Volker Arolt, Walter Heindel, Bernhard T Baune, Jürgen Wellmann, Hans-Werner Hense and Klaus Berger
Abstract: BACKGROUND: Depression and cardiovascular diseases due to arteriosclerosis are both frequent and impairing conditions. Depression and (subclinical) arteriosclerosis appear to be related in a bidirectional way, and it is plausible to assume a partly joint causal relationship. However, the biological mechanisms and the behavioral pathways that lead from depression to arteriosclerosis and vice versa remain to be exactly determined. METHODS/DESIGN: This study protocol describes the rationale and design of the prospective BiDirect Study that aims at investigating the mutual relationship between depression and (subclinical) arteriosclerosis. BiDirect is scheduled to follow-up three distinct cohorts of individuals ((i) patients with acute depression (N = 999), (ii) patients after an acute cardiac event (N = 347), and (iii) reference subjects from the general population (N = 912)). Over the course of 12 years, four personal examinations are planned to be conducted. The core examination program, which will remain identical across follow-ups, comprises a personal interview (e.g. medical diagnoses, health care utilization, lifestyle and risk behavior), a battery of self-administered questionnaires (e.g. depressive symptoms, readiness to change health behavior, perceived health-related quality of life), sensory (e.g. olfaction, pain) and neuropsychological (e.g. memory, executive functions, emotional processing, manual dexterity) assessments, anthropometry, body impedance measurement, a clinical work-up regarding the vascular status (e.g. electrocardiogram, blood pressure, intima media thickness), the taking of blood samples (serum and plasma, DNA), and structural and functional resonance imaging of the brain (e.g. diffusion tensor imaging, resting-state, emotional faces processing). The present report includes BiDirect-Baseline, the first data collection wave. DISCUSSION: Due to its prospective character, the integration of three distinct cohorts, the long follow-up time window, the diligent diagnosis of depression taking depression subtypes into account, the consideration of relevant comorbidities and risk factors, the assessment of indicators of (subclinical) arteriosclerosis in different vascular territories, and the structural and functional brain imaging that is performed for a large number of participants, the BiDirect Study represents an innovative approach that combines population-based cohorts with sophisticated clinical work-up methods and that holds the potential to overcome many of the drawbacks characterizing earlier investigations.
Keywords: Brain; Humans; Arteriosclerosis; Questionnaires; Risk Factors; Prospective Studies; Emotions; Depressive Disorder; Comorbidity; Quality of Life; Adult; Aged; Middle Aged; Female; Male; Asymptomatic Diseases; Carotid Intima-Media Thickness
Rights: © 2014 Teismann et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
RMID: 0030023093
DOI: 10.1186/1471-244X-14-174
Appears in Collections:Medicine publications

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