Depressive symptoms are psychological risk factors for cardiovascular disease. They seem to independently predict cardiovascular disease incidence and all-cause mortality, but it is not yet determined whether a specific subtype of depressive symptoms is especially accountable for the risk increase.

This study aimed to investigate depressive symptoms – combined and divided into melancholic and non-melancholic subtypes – in a middle-aged cardiovascular risk population; specifically, their association with hypertension awareness, selfrated health, cardiovascular morbidity, and all-cause mortality.

A population-based sample of middle-aged cardiovascular risk persons (n = 2676) was drawn from the Harjavalta Risk Monitoring for Cardiovascular Disease Project. At baseline, the health and lifestyle habits of the subjects were comprehensively assessed, including depressive symptoms with Beck’s Depression Inventory. Data on cardiovascular morbidity and all-cause mortality were registerbased.

At baseline, the prevalence of increased melancholic and non-melancholic depressive symptoms was 5 % and 15 %, respectively. Predictors of depressive symptoms were female gender, obesity, harmful alcohol use, smoking, low leisuretime physical activity, awareness of hypertension, and poor self-rated health. Among those with poor self-rated health, increased depressive symptoms modified their perception of physical health. Increased non-melancholic depressive symptoms increased risk for cardiovascular morbidity and all-cause mortality compared to not having increased depressive symptoms even in adjusted models.

In conclusion, increased depressive symptoms are prevalent among middle-aged cardiovascular risk subjects. They are associated with many traditional cardiovascular risk factors and poor self-rated health. Thus, assessing self-rated health might be a practical tool in cardiovascular risk management. Specifically, non-melancholic depressive symptoms influence risk persons’ prognosis, and recognition of these symptoms should be emphasised.