TY - JOUR
T1 - Psychological distress and ischaemic heart disease
T2 - Cause or consequence? Evidence from a large prospective cohort study
AU - Welsh, Jennifer
AU - Korda, Rosemary J.
AU - Joshy, Grace
AU - Butterworth, Peter
AU - Brown, Alex
AU - Banks, Emily
N1 - Funding Information:
The authors thank John Attia, Prasuna Reddy and Ellie Paige for their work on an earlier version of this analysis. This research was conducted in partnership with the National Heart Foundation of Australia, NSW Agency for Clinical Innovation and Consumers Health Forum of Australia. This research was completed using data collected through the 45 and Up Study (www. saxinstitute. org. au). The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW; and partners: the National Heart Foundation of Australia (NSW Division); NSW Ministry of Health; NSW Government Family & Community Services - Ageing, Carers and the Disability Council NSW; and the Australian Red Cross Blood Service. The authors thank the many thousands of people participating in the 45 and Up Study.The research was funded by a National Health and Medical Research Council of Australia Partnership Grant (GNT1092674). JW is supported by an Australian Government Research Training Program Scholarship. EB issupported by the National Health and Medical Research Council (1042717). PB is supported by the Australian Research Council Future Fellowship FT13101444. AB is supported by a Veirtel Senior Medical Research Fellowship.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Background Ischaemic heart disease (IHD) incidence is elevated in people reporting psychological distress. The extent to which this relationship is causal or related to reverse causality-that is, undiagnosed disease causing distress-is unclear. We quantified the relationship between psychological distress and IHD, with consideration of confounding and undiagnosed disease. Methods Questionnaire data (2006-2009) from 151 811 cardiovascular disease-free and cancer-free Australian general population members aged ≥45years (45 and Up Study) were linked to hospitalisation and mortality data, to December 2013. A two-stage approach estimated HRs for incident IHD (IHD-related hospitalisation or death) for low (Kessler-10 scores: 10-<12), mild (12-<16), moderate (16-<22) and high (22-50) psychological distress, adjusting for demographic and behavioural characteristics, and then restricting to those with no/minor functioning limitations (likely free from undiagnosed disease). Results Over 859 396 person-years, 5230 incident IHD events occurred (rate: 6.09/1000person-years). IHD risk was increased for mild (age-adjusted and sex-adjusted HR: 1.18, 95% CI 1.11 to 1.26), moderate (1.36, 1.25 to 1.47), and high (1.69, 1.52 to 1.88) versus low distress. HRs attenuated to 1.15 (1.08 to 1.22), 1.26 (1.16 to 1.37) and 1.41 (1.26 to 1.57) after adjustment for demographic and behavioural characteristics and were further attenuated by 35%-41% in those with no/minor limitations, leaving a significant but relatively weak doseresponse relationship: 1.11 (1.02 to 1.20), 1.21 (1.08 to 1.37) and 1.24 (1.02 to 1.51) for mild, moderate and high versus low distress, respectively. The observed adjustment-related attenuation suggests measurement error/residual confounding likely contribute to the remaining association. Conclusion A substantial part of the distress-IHD association is explained by confounding and functional limitations, an indicator of undiagnosed disease.Emphasis should be on psychological distress as a marker of healthcare need and IHD risk, rather than a causative factor.
AB - Background Ischaemic heart disease (IHD) incidence is elevated in people reporting psychological distress. The extent to which this relationship is causal or related to reverse causality-that is, undiagnosed disease causing distress-is unclear. We quantified the relationship between psychological distress and IHD, with consideration of confounding and undiagnosed disease. Methods Questionnaire data (2006-2009) from 151 811 cardiovascular disease-free and cancer-free Australian general population members aged ≥45years (45 and Up Study) were linked to hospitalisation and mortality data, to December 2013. A two-stage approach estimated HRs for incident IHD (IHD-related hospitalisation or death) for low (Kessler-10 scores: 10-<12), mild (12-<16), moderate (16-<22) and high (22-50) psychological distress, adjusting for demographic and behavioural characteristics, and then restricting to those with no/minor functioning limitations (likely free from undiagnosed disease). Results Over 859 396 person-years, 5230 incident IHD events occurred (rate: 6.09/1000person-years). IHD risk was increased for mild (age-adjusted and sex-adjusted HR: 1.18, 95% CI 1.11 to 1.26), moderate (1.36, 1.25 to 1.47), and high (1.69, 1.52 to 1.88) versus low distress. HRs attenuated to 1.15 (1.08 to 1.22), 1.26 (1.16 to 1.37) and 1.41 (1.26 to 1.57) after adjustment for demographic and behavioural characteristics and were further attenuated by 35%-41% in those with no/minor limitations, leaving a significant but relatively weak doseresponse relationship: 1.11 (1.02 to 1.20), 1.21 (1.08 to 1.37) and 1.24 (1.02 to 1.51) for mild, moderate and high versus low distress, respectively. The observed adjustment-related attenuation suggests measurement error/residual confounding likely contribute to the remaining association. Conclusion A substantial part of the distress-IHD association is explained by confounding and functional limitations, an indicator of undiagnosed disease.Emphasis should be on psychological distress as a marker of healthcare need and IHD risk, rather than a causative factor.
UR - http://www.scopus.com/inward/record.url?scp=85031744947&partnerID=8YFLogxK
U2 - 10.1136/jech-2017-209535
DO - 10.1136/jech-2017-209535
M3 - Article
C2 - 28928223
AN - SCOPUS:85031744947
VL - 71
SP - 1084
EP - 1089
JO - Journal of Epidemiology and Community Health
JF - Journal of Epidemiology and Community Health
SN - 0143-005X
IS - 11
ER -