Ethnic differences in the association between cardiovascular risk factors and psychological distress in a population study in the Netherlands.

Agnes C Schrier,Aartjan T F Beekman,Matty A S De Wit,Arnoud P Verhoeff,Jack Dekker,Ralph Kupka,Joanne K Ujcic-Voortman

doi:10.1186/1471-2458-12-1090

Abstract

BackgroundThere is growing body of evidence of an association between cardiovascular risk factors and depressive and anxiety symptoms. The purpose of this study was to investigate whether these associations are similar in ethnic minority groups.MethodsA random urban population sample, aged 18+, stratified by ethnicity (484 native Dutch subjects, 383 Turkish-Dutch subjects, and 316 Moroccan-Dutch subjects), in Amsterdam, the Netherlands, was interviewed with the Kessler Psychological Distress scale (K10) in combination with measurements of several cardiovascular risk factors. The association of psychological distress (defined as a K10 score above cut-off of 20) with cardiovascular risk factors (obesity, abdominal obesity, hypertension, hypercholesterolemia, low HDL cholesterol levels or diabetes), ethnicity and their interaction was analyzed using logistic regression analyses, stratified by gender and adjusted for age.ResultsCardiovascular risk factors were not significantly associated with psychological distress in any of the gender/ethnic groups, with the exception of a positive association of obesity and hypertension with psychological distress in native Dutch women and a negative association of hypertension and psychological distress in Turkish men. Interaction terms of cardiovascular risk factors and ethnicity were approaching significance only in the association of obesity with the K10 in women.ConclusionIn this cross-sectional multi-ethnic adult population sample the majority of the investigated cardiovascular risk factors were not associated with psychological distress. The association of obesity with psychological distress varies by gender and ethnicity. Our findings indicate that the prevention of obesity and psychological distress calls for an integrated approach in native Dutch women, but not necessarily in Turkish-Dutch and Moroccan-Dutch women, in whom these problems may be targeted separately.

Highlights

There is growing body of evidence of an association between cardiovascular risk factors and depressive and anxiety symptoms
In a population study in Amsterdam we showed that obesity and abdominal obesity are far more common among Turkish-Dutch and Moroccan-Dutch women than among native Dutch women [18]
Hypercholesterolemia, low HDL cholesterol and diabetes were not associated with psychological distress

Summary

Introduction

There is growing body of evidence of an association between cardiovascular risk factors and depressive and anxiety symptoms. In particular the findings from longitudinal studies showing that waist circumference predisposes to depression and between cardiovascular risk factors and depression, because studies report a stronger association between obesity and depression in whites than in blacks or Hispanics in the US population [11,12,13]. This applies to obesity, and to the metabolic syndrome, a constellation of cardiovascular risk factors of metabolic origin: depressive symptoms increase the odds of metabolic syndrome in white, but not in black, individuals [14]. Studies with a broader range of race/ethnicity may help to clarify the contribution of social and cultural influences to the relationship between cardiovascular risk factors and mood or anxiety syndromes

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