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Associations between DSM-IV mental disorders and subsequent heart disease onset: beyond depression
Kate M Scott1, Peter de Jonge, Jordi Alonso
1Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
Insights
Mental health conditions like depression and anxiety are linked to heart disease onset. This study highlights the broad impact of psychopathology on cardiovascular health, with implications for public health.
Area of Science:
- Psychiatry and Cardiology
- Epidemiology of Mental Disorders
- Public Health Research
Background:
- Previous research on depression and heart disease lacked diagnostic rigor and consideration of comorbid mental health conditions.
- The specific association between depression and heart disease, independent of other disorders, remained unclear.
- The comparative risk of various mental disorders for heart disease onset was not well-established.
Purpose of the Study:
- To investigate the association between a range of mental disorders and the subsequent onset of heart disease.
- To determine if the link between depression and heart disease is specific or due to comorbid conditions.
- To assess the relative impact of different mental disorders on heart disease risk.
Main Methods:
- A large-scale, multinational household survey (n=52,095) assessed lifetime prevalence of 16 mental disorders using the Composite International Diagnostic Interview.
- Heart disease was defined by self-report of physician diagnosis or heart attack.
- Survival analyses were employed to examine the relationship between the onset of mental disorders and subsequent heart disease.
Main Results:
- Comorbidity-adjusted analyses revealed associations between depression, panic disorder, specific phobia, post-traumatic stress disorder, and alcohol use disorders with heart disease onset (ORs 1.3-1.6).
- A dose-response relationship was observed between the number of mental disorders and heart disease risk.
- Mood disorders and alcohol abuse showed stronger associations with earlier onset heart disease, with no significant gender differences.
Conclusions:
- Depression, anxiety, and alcohol use disorders are significantly associated with heart disease onset, though depression was the weakest predictor among these.
- The findings suggest a broad link between psychopathology and heart disease, underscoring significant clinical and public health implications.
- Further prospective research is recommended to confirm these associations and their clinical relevance.
Background:
Prior studies on the depression-heart disease association have not usually used diagnostic measures of depression, or taken other mental disorders into consideration. As a result, it is not clear whether the association between depression and heart disease onset reflects a specific association, or the comorbidity between depression and other mental disorders. Additionally, the relative magnitude of associations of a range of mental disorders with heart disease onset is unknown.
Methods:
Face-to-face household surveys were conducted in 19 countries (n=52,095; person years=2,141,194). The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Heart disease was indicated by self-report of physician's diagnosis, or self-report of heart attack, together with their timing (year). Survival analyses estimated associations between first onset of mental disorders and subsequent heart disease onset.
Results:
After comorbidity adjustment, depression, panic disorder, specific phobia, post-traumatic stress disorder and alcohol use disorders were associated with heart disease onset (ORs 1.3-1.6). Increasing number of mental disorders was associated with heart disease in a dose-response fashion. Mood disorders and alcohol abuse were more strongly associated with earlier onset than later onset heart disease. Associations did not vary by gender.
Conclusions:
Depression, anxiety and alcohol use disorders were significantly associated with heart disease onset; depression was the weakest predictor. If confirmed in future prospective studies, the breadth of psychopathology's links with heart disease onset has substantial clinical and public health implications.
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