Mental disorders and cardiovascular disease among adults in the United States

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Abstract

Objective

Numerous population-based studies have found an association between major depression and CVD, though these studies did not assess anxiety disorders. Patient samples have shown associations between anxiety disorders and cardiovascular disease (CVD), but without consideration of depressive disorders. Therefore, it remains unclear whether: (a) both anxiety and depressive disorder are associated with CVD; (b) these associations are generalizable to adults in the community.

Materials and Methods

Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,093 civilian non-institutionalized participants aged 18 and older.

Results

CVD (total prevalence 3.3%) was associated with increased likelihood of any anxiety disorder (OR = 1.43, (1.20, 1.71)), after adjusting for depressive disorders, as well as Generalized Anxiety Disorder (OR = 1.48 (1.09, 2.01)), Panic disorder (OR = 1.46 (1.12, 1.91)), and specific phobia (OR = 1.29 (1.04, 1.59)). CVD was significantly associated with any mood disorder (OR = 1.34 (1.13, 1.58)) after adjusting for anxiety disorders, though neither the link with major depression, nor other specific mood disorders remained significant after adjustment.

Conclusions

Our findings suggest that anxiety disorders, mood disorders, and CVD are highly comorbid among adults in the United States, and demonstrate the importance of including anxiety disorder assessment in studies of mental and physical comorbidity. These results reveal how the lack of investigation into specific relationships between CVD and the range of mental disorders in population-based studies of risk factors for CVD may obscure important relationships.

Section snippets

Sample

The cross-sectional sample was drawn from participants in the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative United States survey of 43,093 civilian non-institutionalized participants aged 18 and older. Details of the sampling frame are described elsewhere (Grant et al., 2003b, Grant et al., 2004a, Compton et al., 2004). The National Institute on Alcohol Abuse and Alcoholism (NIAAA) sponsored the study and supervised the

Socio-demographic characteristics and behavioral factors associated with CVD

The prevalence of heart disease varies across socio-demographic and clinical characteristics. Specifically, individuals who are older, Native American or White, widowed/separated/divorced, have less than a high school education, have low personal income, and have a history of nicotine dependence have a higher prevalence of CVD (see Table 1).

Comorbidity of CVD and mental disorders

All of the mental disorders were significantly comorbid with CVD prevalence in unadjusted logistic regression models (see Table 2). However, after adjusting

Discussion

The majority of studies on the mental health predictors, correlates and outcomes associated with CVD focus on major depression, and subclinical measures of depression symptoms. Epidemiologic studies with state of the art sampling and measurement of CVD typically include only depression symptom scales, and sometimes structured interviews used to identify diagnoses of depression, but do not usually assess anxiety disorders (Haines et al., 1987, Barlow, 1988, Stansfeld and Marmot, 2002, Kubzansky

Conflicts of interest

None declared.

Acknowledgement

The authors have no financial or personal conflicts of interest. This work was supported by NIDA Grant # DA 20896 to Dr. Goodwin.

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