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CHD, risk factors may increase risk for psychological distress
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The incidence of CHD and its related risk factors may increase the risk for development of long-lasting psychological distress from midlife to old age, according to new data from the Whitehall II study.
“Recently, subclinical common mental disorder, defined for example, as the presence of psychological distress, has also received attention because of its high prevalence in general populations and associations with future clinical depression, morbidity and mortality,” Marianna Virtanen, of the Finnish Institute of Occupational Health in Helsinki, and colleagues wrote in the study background. “Although there is evidence that CHD in particular and, to a lesser extent, its risk factors might increase the risk of depressive symptoms in the short term, their contribution to long-term trajectories of symptoms has rarely been examined and the findings are inconsistent.”
Data were gathered from Whitehall II, a prospective cohort study of British government employees. The cohort (n = 6,890; mean age, 49.5 years) was evaluated at baseline for CHD and its risk factors (obesity, smoking, diabetes, hypertension and cholesterol). Participants had up to seven repeat assessments over 21 years to evaluate for psychological distress.
Group trajectory modeling was used to assess clusters of individuals with similar psychological symptoms. The cohort was categorized into four trajectories of psychological distress: persistently low (69% of participants), persistently intermediate (13%), intermediate to low (12%) and persistently high (7%).
CHD and distress
Using persistently low trajectory for reference and adjusting for sociodemographic factors, the researchers found CHD was associated with the persistently intermediate trajectory (OR = 1.62; 95% CI, 1.08-2.41), the intermediate to low trajectory (OR = 1.92; 95% CI, 1.24-2.99) and the persistently high trajectory (OR = 2.41; 95% CI, 1.49-3.87).
After further adjustment for smoking, obesity, alcohol use, hypertension, cholesterol, diabetes and history of psychological distress, CHD remained associated with the intermediate to low trajectory (OR = 1.7; 95% CI, 1.08-2.68) and the persistently high trajectory (OR = 1.92; 95% CI, 1.16-3.19), but not the persistently intermediate trajectory (OR = 1.38; 95% CI, 0.91-2.09), according to the researchers.
Smoking and obesity
In terms of the CHD risk factors, compared with the persistently low trajectory, smoking was associated with the following psychological distress trajectories: persistently intermediate (OR = 1.32; 95% CI, 1.06-1.65), intermediate to low (OR = 1.14; 95% CI, 0.89-1.46) and persistently high (OR = 1.49; 95% CI, 1.1-2.01), and obesity was associated with the persistently intermediate trajectory (OR = 1.31; 95% CI, 1.02-1.69), intermediate to low trajectory (OR = 1.07; 95% CI, 0.8-1.43) and persistently high trajectory (OR = 1.47; 95% CI, 1.04-2.08).
After further adjustment for smoking, obesity, alcohol use, hypertension, cholesterol, diabetes and history of psychological distress, smoking remained associated with the persistently intermediate (OR = 1.33; 95% CI, 1.07-1.64) and persistently high (OR = 1.55; 95% CI, 1.19-2.04) trajectories, as did obesity (OR for persistently intermediate = 1.33; 95% CI, 1.04-1.7; OR for persistently high = 1.47; 95% CI, 1.07-2.01), Virtanen and colleagues found.
“Our results add evidence of the potential benefit of tackling obesity and smoking in the attempts to prevent long-lasting mental health problems,” the researchers wrote. “However, further intervention studies are needed to test whether these associations are causal. Further research should also examine the mechanisms, such as systemic inflammation, underlying the link between CHD, obesity, smoking and mental health trajectories.” – by Cassie Homer
Disclosure : The researchers report no relevant financial disclosures.
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