Controlled direct effect of psychiatric disorders on cardiovascular disease: evidence from a large Kurdish cohort

Abstract

Background: Psychiatric disorders are significantly associated with the incidence and prevalence of cardiovascular diseases, mortality, hospital readmissionn. Oral and dental hygiene may play a role in such association. This study aimed to evaluate the controlled direct effect of psychiatric disorders on cardiovascular diseases by controlling the mediating effect of oral and dental hygiene.

Methods: The data used for this study came from the baseline phase of Ravansar Non-communicable Disease (RaNCD) cohort study. RaNCD cohort study is including a representative sample of 10,065 adults (35-65 years old) living in Ravansar, a city in the west of Iran. The marginal structural model with stabilized inverse probability weights accounted for potential confounders was used to estimate the controlled direct effect of psychiatric disorders on cardiovascular diseases. Three different models using three mediators including oral and dental hygiene behaviors, oral ulcer and lesions, and decayed, missing, and filled tooth, were used.

Results: Psychiatric disorders increase the odds of cardiovascular diseases by 83% (OR = 1.83, CI 1.27, 2.61) and about two times (OR = 2.14, 95% CI 1.74, 2.63) when controlled for oral and dental hygiene behaviors, and oral ulcer and lesions as mediators, respectively. When decayed, missing, and filled tooth, as a mediator, was set at ≤ 8, there was no statistically significant controlled direct effect of psychiatric disorders on cardiovascular diseases (OR = 0.90, 95% CI 0.62, 1.30).

Conclusion: Our results suggested that psychiatric disorder was directly related to cardiovascular diseases even if it was possible to have good oral and dental hygiene. The results suggested that interventions targeting people with psychiatric disorders could reduce prevalence of the cardiovascular diseases.

Keywords: Cardiovascular disease; Controlled direct effect; Oral and dental hygiene; Psychiatric disorders.

Fig. 1

DAG of the hypothesized causal pathway between psychiatric disorder and CVD. DMFT: Decayed, Missing, Filled Tooth, DAG: Directed Acyclic Graph, c₁ (confounder1): Age, Sex, Smoking, Educational, Diabetes mellitus, c₂ (confounder2): Age, Sex, Smoking, BMI, Physical activity, Diet, Sleep time, L (Exposure-induced mediator-outcome confounders): Age, sex, Hypertension, Diabetes mellitus, Physical activity, Drinking, Hypercholesterolemia, SES, education, diet, BMI, Smoking, Drug use, Sugar use