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Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study
Stephen A Stansfeld1, Rebecca Fuhrer, Martin J Shipley
1Department of Psychiatry, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, London, UK. S.A.Stansfield@qmw.ac.uk
Insights
Psychological distress increases coronary heart disease (CHD) risk in men, independent of lifestyle and work factors. This association was not consistently found in women, suggesting gender-specific mechanisms in CHD development.
Area of Science:
- Cardiology
- Psychiatry
- Occupational Health
Background:
- Psychological distress and psychiatric disorders are recognized risk factors for coronary heart disease (CHD).
- Understanding the mechanisms linking psychological distress to CHD is crucial for effective prevention strategies.
- This study investigates the association between psychological distress and CHD, exploring potential mediating factors.
Purpose of the Study:
- To confirm the association between psychological distress and CHD.
- To examine if this association is explained by health behaviors, social isolation, or work-related factors.
- To investigate potential gender differences in the psychological distress-CHD relationship.
Main Methods:
- Prospective occupational cohort study (Whitehall II Study) of London civil servants.
- Baseline data (1985-1988) and 5-year follow-up.
- Psychological distress measured by the General Health Questionnaire (GHQ); CHD incidence assessed via self-report and electrocardiographic (ECG) abnormalities.
Main Results:
- Psychological distress at baseline predicted increased incidence of self-reported CHD and ECG abnormalities in men (ORs 1.83 and 1.51, respectively).
- In women, psychological distress predicted increased CHD incidence (OR 1.60) but not ECG abnormalities.
- Adjustments for mediating factors reduced CHD risk by 10-12% in both genders; however, these adjustments increased risk for ECG abnormalities in men.
Conclusions:
- Psychological distress independently confers an increased risk of CHD in men.
- The association between psychological distress and CHD risk is not consistently demonstrated in women.
- Findings highlight the importance of psychological well-being in cardiovascular health, particularly for men.
Background:
Psychiatric disorder and psychological distress are increasingly recognized as risk factors for coronary heart disease (CHD). Elucidation of the mechanisms of these associations has implications for prevention. This study aims to confirm the association between psychological distress and CHD and examine if it could be explained by other factors such as health behaviours, social isolation and low control at work.
Methods:
A prospective occupational cohort study of London-based civil service employees (Whitehall II Study) with baseline data collected from 1985-1988 with a 5-year follow-up. The participants were male and female middle-aged civil servants working in 20 Government Departments; 73% of eligible employees attended baseline screening. Psychological distress measured by the General Health Questionnaire (GHQ) at baseline was used to predict incidence of self-reported CHD and possible and probable electrocardiographic (ECG) abnormalities during follow-up.
Results:
In men, baseline psychological distress was associated with an increased incidence of overall self-reported CHD (odds ratios [OR] = 1.83, 95% CI : 1.5-2.3) and ECG abnormalities (OR = 1.51, 95% CI : 1.1-2.1), after adjustment for age, employment grade and length of follow-up. In women, baseline psychological distress was also associated with an increased incidence of CHD (OR = 1.60, 95% CI : 1.2-2.1), but not with ECG abnormalities. Adjustment for health behaviours, marital status, social networks and work characteristics reduced the risks for incident CHD by 12% in men and by 10% in women; for ECG abnormalities these adjustments increased the risk in men by 16% and had little effect in women.
Conclusions:
The experience of psychological distress confers increased risk of CHD in men that is not explained by health behaviours, social isolation or work characteristics. The increased risk of CHD associated with psychological distress is not consistently demonstrated in women.