Abstract
Objective:Despite the long-term decline, heart disease has remained the leading cause of death in the United States (US) over the past eight decades, accounting for 23% of all deaths in 2017. Although psychological distress has been associated with cardiovascular disease mortality, the relationship between different psychological distress levels and heart disease mortality in the US has not been analyzed in detail. Using a national longitudinal dataset, we examined the association between levels of psychological distress and US heart disease mortality.Methods:We analyzed the Kessler 6-item psychological distress scale as a risk factor for heart disease mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N=513,081). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates.Results:In Cox models with 18 years of mortality follow-up, the heart disease mortality risk was 121% higher (hazard ratio [HR]=2.21; 95% CI=1.99,2.45) in adults with serious psychological distress (SPD) (p<0.001), controlling for age, and 96% higher (HR=1.96; 95% CI=1.77,2.18) in adults with SPD (p<0.001), controlling for age, gender, race/ethnicity, immigrant status, education, marital status, poverty status, housing tenure, and geographic region when compared with adults without psychological distress. The relative risk of heart disease mortality associated with SPD decreased but remained significant (HR=1.14, 95% CI=1.02,1.28) after controlling for additional covariates of smoking, alcohol consumption, self-assessed health, activity limitation, and body mass index. There was a dose-response relationship, with relative risks of heart disease mortality increasing consistently at higher levels of psychological distress. Moreover, the association varied significantly by gender and race/ethnicity. The relative risk of heart disease mortality for those who experienced SPD was 2.42 for non-Hispanic Whites and 1.76 for non-Hispanic Blacks, compared with their counterparts who did not experience psychological distress.Conclusions and Global Health Implications:US adults with serious psychological distress had statistically significantly higher heart disease mortality risks than those without psychological distress. These findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing heart disease mortality.
Highlights
Heart disease is the most costly health condition among leading chronic diseases.[1]
A metaanalysis of 28 studies showed that the overall risk of depression on cardiovascular disease (CVD) was 1.46.11 The relative risk varied by populations and methodology, ranging from 1.32 to 1.57.11 Despite the well-established morbidity studies, there are few studies on the association between psychological distress and heart disease mortality
Psychological distress, which is a general term for symptoms of depression and anxiety, has been associated with CVD morbidity and mortality,including heart disease mortality,[8,11,12,14,15,17,18,19] the relationship between different levels of psychological distress and heart disease mortality in the United States (US) has not been analyzed in detail using longitudinal data. It is not known whether heart disease mortality increases relative to increases in psychological distress and whether this relationship varies by gender, race/ ethnicity, and socioeconomic status (SES). To address this gap in research, we examine the association between psychological distress levels and heart disease mortality rates and relative risks in the US, using a nationally representative longitudinal dataset with an 18-years of mortality follow-up and five categories of the Kessler 6 (K6) nonspecific distress scale
Summary
Heart disease is the most costly health condition among leading chronic diseases.[1]. Psychological distress including depression and anxiety have been associated with CVD, including heart disease and stroke.[8,9,10,11,12,13,14] A metaanalysis of 28 studies showed that the overall risk of depression on CVD was 1.46.11 The relative risk varied by populations and methodology, ranging from 1.32 to 1.57.11 Despite the well-established morbidity studies, there are few studies on the association between psychological distress and heart disease mortality. Rasul and colleagues found an association between psychological distress and coronary heart disease mortality, using the 30item General Health Questionnaire (GHQ-30), among adults aged 45-64 years in urban Scotland.[10] Another study found that those with depression have a higher risk of cardiac mortality, compared with non-depressed adults, for both cardiac patients and adults without cardiac disease, aged 55-85 years in the Netherlands.[15] Russ et al found that, among adults aged 35 years and older in England, psychological distress measuring GHQ was associated with CVD mortality.[16]
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