Abstract
ObjectiveTo examine coronary heart disease (CHD) and its risk factors as predictors of long-term trajectories of psychological distress from midlife to old age.MethodsIn the Whitehall II cohort study, 6890 participants (4814 men, 2076 women; mean age 49.5 years) had up to seven repeat assessments of psychological distress over 21 years (mean follow-up 19 years). CHD and its risk factors (lifestyle-related risk factors, diabetes, hypertension and cholesterol) were assessed at baseline. Group-based trajectory modelling was used to identify clusters of individuals with a similar pattern of psychological distress over time.ResultsWe identified four trajectories of psychological distress over the follow-up: ‘persistently low’ (69% of the participants), ‘persistently intermediate’ (13%), ‘intermediate to low’ (12%) and ‘persistently high’ (7%). The corresponding proportions were 60%, 16%, 13% and 11% among participants with CHD; 63%, 15%, 12% and 10% among smokers and 63%, 16%, 12% and 10% among obese participants. In multivariable adjusted multinomial regression analyses comparing other trajectories to persistently low trajectory, prevalent CHD was associated with intermediate to low (OR 1.70, 95% CI 1.08 to 2.68) and persistently high (OR 1.92, 95% CI 1.16 to 3.19) trajectories. Smoking (OR 1.33, 95% CI 1.07 to 1.64; OR 1.55, 95% CI 1.19 to 2.04) and obesity (OR 1.33, 95% CI 1.04 to 1.70; OR 1.47, 95% CI 1.07 to 2.01) were associated with persistently intermediate and persistently high trajectories, respectively.ConclusionCHD, smoking and obesity may have a role in the development of long-lasting psychological distress from midlife to old age.
Highlights
Depression is a major public health issue characterised by high lifetime onset, persistence over time and recurrence.[1]
We show the age sex and socioeconomic status adjusted associations from multinomial regression analyses of baseline sociodemographic characteristics and coronary heart disease (CHD) risk factors with the psychological distress trajectories, setting persistently low as a reference group
Female sex, smoking and obesity were associated with the likelihood of being on persistently intermediate symptom trajectory; younger age and female sex were associated with intermediate to low trajectory and younger age, female sex, intermediate and low socioeconomic status, smoking and obesity were associated with persistently high symptom trajectory
Summary
Depression is a major public health issue characterised by high lifetime onset, persistence over time and recurrence.[1]. In one study of older women, self-reported myocardial infarction (MI) and hypertension predicted increasing and persistently high symptom trajectories,[10] while another study of older men and women did not find such associations.[11]
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