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Do depression and anxiety mediate the link between educational attainment and CHD?
Rebecca C Thurston1, Laura D Kubzansky, Ichiro Kawachi
1Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA. thurstonrc@upmc.edu
Psychosomatic Medicine
|February 2, 2006
Summary
Lower education and higher depression/anxiety increase coronary heart disease (CHD) risk. However, these mental health symptoms do not explain the link between education and CHD, suggesting other factors are involved.
Area of Science:
- Epidemiology
- Public Health
- Psychosomatic Medicine
Background:
- Socioeconomic status (SES) is linked to coronary heart disease (CHD), with mental health potentially mediating this relationship.
- Educational attainment, a key indicator of SES, is associated with increased risk of developing CHD.
- The mediating roles of depression and anxiety in the SES-CHD link remain under-examined.
Purpose of the Study:
- To investigate whether depression and anxiety mediate the association between educational attainment and incident CHD.
- To analyze the relationship between educational levels, depressive and anxious symptoms, and CHD risk in a US population sample.
Main Methods:
- Utilized data from the National Health and Nutrition Examination Survey (NHANES) I and follow-up studies (n=6265, ages 25-74).
- Assessed educational attainment, depressive and anxious symptoms (General Well-Being Schedule), and incident CHD (hospital records, death certificates).
- Employed logistic regression and Cox proportional hazards models for statistical analysis.
Main Results:
- Lower educational attainment (less than high school, some college) was associated with increased CHD risk compared to a college education.
- Higher levels of depressive and anxious symptoms were independently linked to significantly increased CHD risk.
- While lower education correlated with higher symptom levels, these symptoms explained only a small portion of the education-CHD association.
Conclusions:
- Educational attainment and symptoms of depression and anxiety are independently associated with CHD risk.
- Depressive and anxious symptoms are more prevalent in individuals with lower educational attainment.
- These mental health symptoms do not appear to mediate the relationship between education and CHD, highlighting the need for interventions addressing socioeconomic disadvantage and negative affect.