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. 2021 Feb 16;11(2):e039628.
doi: 10.1136/bmjopen-2020-039628.

Does psychological distress directly increase risk of incident cardiovascular disease? Evidence from a prospective cohort study using a longer-term measure of distress

Jennifer Welsh  1 , Emily Banks  2   3 , Grace Joshy  2 , Peter Butterworth  2   4 , Lyndall Strazdins  2 , Rosemary J Korda  2
Affiliations

Does psychological distress directly increase risk of incident cardiovascular disease? Evidence from a prospective cohort study using a longer-term measure of distress

Jennifer Welsh et al. BMJ Open. .

Abstract

Objective: Cardiovascular disease (CVD) incidence is elevated among people with psychological distress. However, whether the relationship is causal is unclear, partly due to methodological limitations, including limited evidence relating to longer-term rather than single time-point measures of distress. We compared CVD relative risks for psychological distress using single time-point and multi-time-point assessments using data from a large-scale cohort study.

Design: We used questionnaire data, with data collection at two time-points (time 1: between 2006 and 2009; time 2: between 2010 and 2015), from CVD-free and cancer-free 45 and Up Study participants, linked to hospitalisation and death records. The follow-up period began at time 2 and ended on 30 November 2017. Psychological distress was measured at both time-points using Kessler 10 (K10), allowing assessment of single time-point (at time 2: high (K10 score: 22-50) vs low (K10 score: <12)) and multi-time-point (high distress (K10 score: 22-50) at both time-points vs low distress (K10 score: <12) at both time-points) measures of distress. Cox regression quantified the association between distress and major CVD, with and without adjustment for sociodemographic and health-related characteristics, including functional limitations.

Results: Among 83 906 respondents, 7350 CVD events occurred over 410 719 follow-up person-years (rate: 17.9 per 1000 person-years). Age-adjusted and sex-adjusted rates of major CVD were elevated by 50%-60% among those with high versus low distress for both the multi-time-point (HR=1.63, 95% CI 1.40 to 1.90) and single time-point (HR=1.53, 95% CI 1.39 to 1.69) assessments. HRs for both measures of distress attenuated with adjustment for sociodemographic and health-related characteristics, and there was little evidence of an association when functional limitations were taken into account (multi-time-point HR=1.09, 95% CI 0.93 to 1.27; single time-point HR=1.14, 95% CI 1.02 to 1.26).

Conclusion: Irrespective of whether a single time-point or multi-time-point measure is used, the distress-CVD relationship is substantively explained by sociodemographic characteristics and pre-existing physical health-related factors.

Keywords: depression & mood disorders; epidemiology; ischaemic heart disease.

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Conflict of interest statement

Competing interests: None declared.

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