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Psychological Distress as a Predictor of CHD Events in Men: The Effect of Persistence and Components of Risk

From the Department of Epidemiology and Public Health, International Centre for Health and Society, University College, London, UK (A.N., M.M.); and the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada (R.F.).

Address correspondence and reprint requests to Amanda Nicholson, Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT. E-mail: amanda.nicholson{at}ucl.ac.uk

Objective: This paper examines the role of psychological distress in the etiology of coronary heart disease (CHD), with particular reference to the persistence of distress symptoms, the contribution that undetected CHD at baseline makes to the observed associations and to the effect of separate components of psychological distress.

Method: 5449 men in an occupational cohort (79% of the total), with at least two prior measurements of the General Health Questionnaire (GHQ-30), were followed for CHD events (including CHD death, nonfatal myocardial infarction (MI), and angina) for (mean) 6.8 years. Psychological distress was measured using the GHQ-30, and general/anxiety, depression and sleep subscales were created based on a principal components analysis.

Results: Psychological distress increased the risk of CHD events, with the risk highest in men with recent onset of distress. Age-adjusted hazard ratios were 1.48 (1.03–2.13) for persistent and 1.77 (1.13–2.78) for new distress. Angina events accounted for much of the observed associations. This increased risk was independent of conventional CHD risk factors, markers of underlying CHD, or measures of reporting bias, and it was related to anxiety items and sleep disturbance rather than depressive symptoms.

Conclusions: Psychological distress increases the risk of a future diagnosis of angina in men. This risk is not accounted for by the presence of underlying CHD. These results highlight the importance of identifying both the role of underlying atherosclerosis in the pathway linking distress to heart disease and the timing of action of the components of psychological distress.

Key Words: psychological distress • CHD • angina • persistence • acceleration • atherogenic

Abbreviations: CHD = coronary heart disease; GHQ-30 = 30-item General Health Questionnaire; MI = myocardial infarction; BMI = body mass index; ECG = electrocardiogram; MC = Minnesota code.

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