Common mental disorder and physical illness in the Renfrew and Paisley (MIDSPAN) study

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Abstract

Objective and Methods: The relationship between psychological distress measured by the General Health Questionnaire 30 (GHQ-30) and risk factors for coronary heart disease, angina, electrocardiogram (ECG) abnormalities and chronic sputum was modelled using logistic regression on baseline data from a community study of 15,406 men and women. Results: Psychological distress was associated with low forced expiratory volume (FEV1) and low body mass index (BMI) in men, and low systolic blood pressure only in women. There were associations between psychological distress and coronary heart disease and cardiorespiratory outcomes. The associations were particularly strong for angina without ECG abnormalities (Men: OR 3.26, 95% CI 2.52–4.21; Women: OR 2.89, 95% CI 2.35–3.55) and for angina with ECG abnormalities (Men: OR 2.68, 95% CI 2.03–4.52; Women: OR 2.88, 95% CI 1.89–4.39), in both men and women, even after adjusting for classical CHD and cardiorespiratory risk factors. An association between psychological distress and severe chest pain, indicative of previous myocardial infarction, was found in both men and women (Men: OR 1.89, 95% CI 1.44–2.47; Women: OR 1.91, 95% CI 1.48–2.47), respectively, and between psychological distress and ECG ischaemia, but in men only (OR 1.32, 95% CI 1.00–1.76). Conclusion: The association between psychological distress and cardiorespiratory outcomes is likely to be a consequence of the pain and discomfort of the symptoms of the illness. Chest pain may also be a symptom of psychological distress. However, psychological distress, as a predictor and possible risk factor increasing the risk of coronary heart disease, cannot be ruled out.

Introduction

The comorbidity of psychiatric disorders with chronic health conditions is a topic of considerable clinical and policy interest. It is important that both clinicians and policy makers recognise the implications for health-related quality of life that result from comorbidity of psychiatric disorders with chronic medical illnesses.

Section snippets

Physical illness

There are several potential mechanisms for the association of physical and psychiatric disorders. Psychiatric disturbance may be either a consequence of the experience of physical symptoms or an example of reporting bias, or the result of common risk factors for both physical and psychiatric disorders or it may be an aetiological agent in physical illness.

Using specific measures of depression, community studies have consistently found associations among psychiatric disorder and coronary heart

Respiratory disease and psychological distress

Chronic obstructive pulmonary disease (COPD) may be complicated further by psychiatric comorbidity. Evidence of increased likelihood of the development of depression in patients with COPD has been found in case–control studies [24], [25] and community surveys [26], [27], [28]. However, the evidence for a significant risk of depression in COPD patients remains inconclusive, perhaps due to the poor methodological quality of these studies [29].

In summary, the associations between psychological

Method

The study population and measurement techniques have been described previously [30], [31].

Prevalence of GHQ caseness by risk factors

At baseline, 15.4% (583/3783) of men and 20.3% (949/4683) of women were possible cases of psychiatric disorder on the GHQ.

For both men and women, the prevalence of GHQ caseness was highest in the first quintile of systolic blood pressure (SBP) and lowest in the fourth quintile. There was a statistically significant difference between quintiles of SBP in women but not men (Table 1). There was no consistent association between the prevalence of GHQ caseness and quintiles of DBP.

Prevalence of GHQ

Discussion

The prevalence rate of GHQ caseness found in this study was low compared to that of other community studies [38], [39]. Such a low prevalence rate may reflect stoicism in the sample. Prevalence of GHQ caseness tended to decrease with higher SBP in women. Similarly, GHQ caseness prevalence increased with poorer lung function. Male respondents with angina, whether confirmed or not by ECG, had the highest GHQ caseness prevalence rate. Female respondents with ECG-confirmed angina had a lower GHQ

Conclusion

GHQ caseness was shown to be associated with both CHD and respiratory symptoms and markers. It is unlikely that the relationship between psychological distress and respiratory outcomes arises solely through smoking, as this was controlled for in multivariate analysis. The association is likely to be due to the pain and disability associated with these outcomes. Similarly, with CHD, psychological distress is also likely to be a consequence of the pain and discomfort associated with these

Acknowledgements

The work presented in this article was supported by a grant from the British Heart Foundation (grant no. PG/98170). We would also like to thank Professor Anthony Mann for kindly providing us with information on his initial validation study of the GHQ, and Pauline MacKinnon and Jane Gow for preparation of the data set.

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