Cardiovascular disease and psychiatric comorbidity: the potential role of perseverative cognition

Abstract

The high comorbidity between psychiatric disorders and cardiovascular disease has received increasing attention, yet little is known about the processes linking the two. One plausible contributing mechanism is the tendency of those with psychiatric disorders to ruminate on stressful events. This phenomenon, sometimes called perseverative cognition, can extend the psychological and physiological effects of stress, which could contribute to cardiovascular disease etiology. In this paper, we discuss the potential role of perseverative cognition in mediating the relationship between psychiatric illness and cardiovascular disease. Rumination can delay physiological recovery from acute stress, which in turn has been found to predict future cardiovascular health. This delayed recovery could act as a mechanism in the longitudinal link between worry and cardiovascular health. The cognitive inflexibility that characterizes mood and anxiety disorders may then contribute to disease not by producing greater reactivity, but instead through extending activation, increasing the risks for cardiovascular damage.

Figure 1

This informal theoretical model shows the potential role of perseverative cognition in linking psychiatric disorders and cardiovascular disease. While behavioral and physiological mechanisms have been highlighted (the left and middle pathways, resp.), this figure shows an additional cognitive pathway on the right, in which cardiovascular reactivity is extended due to cognitive fixation on stressful experiences.