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Psychological distress, physical illness, and risk of coronary heart disease
  1. F Rasul1,
  2. S A Stansfeld1,
  3. C L Hart2,
  4. G Davey Smith3
  1. 1Department of Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
  2. 2Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, Glasgow, UK
  3. 3Department of Social Medicine, University of Bristol, Bristol, UK
  1. Correspondence to:
 MrF Rasul
 Department of Psychiatry, Institute of Community Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Mile End Road, London E1 4NS, UK;


Study objective: The aims of this study are to confirm the association between psychological distress and coronary heart disease (CHD) using an epidemiological community study with hospital admissions data and to examine if any association is explained by existing illness.

Design: Prospective cohort study modelling the association between psychological distress, measured using the 30 item general health questionnaire (GHQ), and hospital admissions data for CHD (ICD 410–414), using proportional hazards modelling adjusted for sociodemographic, CHD risk factors, and angina, bronchitis, diabetes, ischaemia, and stroke.

Setting: Two suburbs of Glasgow, Renfrew and Paisley, in Scotland.

Participants: 6575 men and women aged 45–64 years from Paisley.

Main:results: Five year CHD risk in distressed men compared with non-distressed men was 1.78 (95% confidence intervals (CI), 1.15 to 2.75) in age adjusted analysis, 1.78 (95% CI, 1.14 to 2.79) with sociodemographic and CHD risk factor adjustment, and 1.61 (95% CI 1.02 to 2.55) with additional adjustment for existing illness. Psychological distress was unrelated to five year CHD risk in women. In further analysis, compared with healthy, non-distressed men, distressed physically ill men had a greater risk of CHD than non-distressed physically ill men, a relative risk of 4.01 (95% CI 2.42 to 6.66) compared with 2.12 (95% CI 1.35 to 3.32).

Conclusion: The association of psychological distress with an increased risk of five year CHD risk in men could be a function of baseline physical illness but an effect independent of physical illness cannot be ruled out. Its presence among physically ill men greatly increases CHD risk.

  • CHD, coronary heart disease
  • GHQ, general health questionnaire

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  • Funding: the work presented in this article was supported by a grant from the British Heart Foundation (grant no PG/98170) awarded to Professors Stansfeld and Davey Smith, which supported a Research Fellowship for Farhat Rasul.

  • Conflicts of interest: none declared.

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