The effects of psychological distress and its interaction with socioeconomic position on risk of developing four chronic diseases

Kyle J.J Mclachlan,Catharine R Gale

doi:10.1016/j.jpsychores.2018.04.004

Kyle J.J Mclachlan, Catharine R Gale

Open Access

https://doi.org/10.1016/j.jpsychores.2018.04.004

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Abstract

ObjectiveTo examine the relationship between psychological distress and risk of developing arthritis, cardiovascular disease, chronic obstructive pulmonary disease and diabetes across the range of distress severity, investigate the mediating roles of health behaviours and explore whether the associations vary with socioeconomic position. MethodsParticipants were 16,485 adults from the UK Household Longitudinal Study We examined prospective relationships between psychological distress at baseline (measured using the 12-item General Health Questionnaire) and incidence of arthritis, cardiovascular disease, chronic obstructive pulmonary disease and diabetes (measured using self-report) over 3 years using logistic regression. We then examined the mediating effects of health behaviours and investigated whether the associations varied with socioeconomic position. ResultsDistress significantly increased risk of incident arthritis, cardiovascular disease and chronic obstructive pulmonary disease in a dose-response pattern after controlling for age, sex, socioeconomic position, neighbourhood cohesion, marital status, BMI and baseline disease. High levels of distress (GHQ ≥ 7) increased risk of arthritis (OR 2.22; 1.58–2.13), cardiovascular disease (OR 3.06; 1.89–4.98) and chronic obstructive pulmonary disease (OR 3.25; 1.47–7.18). These associations were partially mediated by smoking status but remained significant after controlling for smoking status, diet and exercise. Distress significantly predicted incident diabetes in manual socioeconomic groups only. Effect sizes did not vary with socioeconomic position for arthritis, cardiovascular disease and chronic obstructive pulmonary disease. ConclusionPsychological distress increases risk of incident arthritis, cardiovascular disease and chronic obstructive pulmonary disease in a dose-response pattern, even at low and moderate distress levels. Future research should investigate the mediating role of inflammatory biomarkers.

Highlights

Clinical depression and anxiety have been linked with the development of a variety of chronic diseases
Higher levels of psychological distress were significantly associated with higher body mass index (BMI), poorer health behaviour, lower socioeconomic position (SEP) and lower neighbourhood cohesion
We found that the relationship between psychological distress and risk of diabetes differs by SEP such that the effect of distress is significant in the manual group but not in the non-manual group

Summary

Introduction

Clinical depression and anxiety have been linked with the development of a variety of chronic diseases. There is evidence from several longitudinal studies that depression and anxiety increase risk of incident arthritis [1,2], cardiovascular disease (CVD) [3,4,5,6,7,8], chronic obstructive pulmonary disease (COPD) [1,9] and diabetes mellitus [10,11,12]. Significant levels of distress (i.e. a GHQ-12 score of four or greater [14,17]) have been found to increase risk of incident CVD [18], COPD [19] and diabetes [20]. No study to date has used GHQ-12 scores to examine the relationships between psychological distress and incidence of chronic diseases across the whole range of distress severity (i.e. comparing the effects of subclinical, moderate and high distress)

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