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Common mental disorder and physical illness in the Renfrew and Paisley (MIDSPAN) study
Farhat Rasul1, Stephen A Stansfeld, C L Hart
1Department of Psychiatry, St. Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary, University of London, London, UK.
Objective And Methods:
The relationship between psychological distress measured by the General Health Questionnaire 30 (GHQ-30) and risk factors for coronary heart disease, angina, electrocardiogram (ECG) abnormalities and chronic sputum was modelled using logistic regression on baseline data from a community study of 15,406 men and women.
Results:
Psychological distress was associated with low forced expiratory volume (FEV(1)) and low body mass index (BMI) in men, and low systolic blood pressure only in women. There were associations between psychological distress and coronary heart disease and cardiorespiratory outcomes. The associations were particularly strong for angina without ECG abnormalities (Men: OR 3.26, 95% CI 2.52-4.21; Women: OR 2.89, 95% CI 2.35-3.55) and for angina with ECG abnormalities (Men: OR 2.68, 95% CI 2.03-4.52; Women: OR 2.88, 95% CI 1.89-4.39), in both men and women, even after adjusting for classical CHD and cardiorespiratory risk factors. An association between psychological distress and severe chest pain, indicative of previous myocardial infarction, was found in both men and women (Men: OR 1.89, 95% CI 1.44-2.47; Women: OR 1.91, 95% CI 1.48-2.47), respectively, and between psychological distress and ECG ischaemia, but in men only (OR 1.32, 95% CI 1.00-1.76).
Conclusion:
The association between psychological distress and cardiorespiratory outcomes is likely to be a consequence of the pain and discomfort of the symptoms of the illness. Chest pain may also be a symptom of psychological distress. However, psychological distress, as a predictor and possible risk factor increasing the risk of coronary heart disease, cannot be ruled out.