A M Roest1, P de Jonge2, C W W Lim3, D J Stein4, A Al-Hamzawi5, J Alonso6, C Benjet7, R Bruffaerts8, B Bunting9, J M Caldas-de-Almeida10, M Ciutan11, G de Girolamo12, C Hu13, D Levinson14, Y Nakamura15, F Navarro-Mateu16, M Piazza17, J Posada-Villa18, Y Torres19, B Wojtyniak20, R C Kessler21, K M Scott22. 1. University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands. Electronic address: a.m.roest@umcg.nl. 2. University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands; University of Groningen, Department of Psychology, Developmental Psychology, Groningen, the Netherlands. 3. Department of Psychological Medicine, University of Otago, Dunedin, New Zealand; Queensland Brain Institute, University of Queensland, St Lucia and Queensland Centre for Mental Health Research, Wacol, Queensland, Australia. 4. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. 5. College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq. 6. IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. 7. Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico. 8. Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg Leuven, Belgium. 9. Psychology Research Institute, Ulster University, Northern Ireland, United Kingdom. 10. Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. 11. National School of Public Health, Management and Professional Development, Bucharest, Romania. 12. IRCCS St John of God Clinical Research Centre, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy. 13. Shenzhen Insitute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China. 14. Ministry of Health Israel, Mental Health Services, Israel. 15. Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan. 16. IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain. 17. National Institute of Health, Peru, Universidad Cayetano Hereidia, Peru. 18. Colegio Mayor de Cundinamarca University, Bogota, Colombia. 19. Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia. 20. Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland. 21. Department of Health Care Policy, Harvard University Medical School, Boston, MA, United States. 22. Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
Abstract
OBJECTIVE: Few studies have been able to contrast associations of anxiety and depression with heart disease. These disorders can be grouped in fear and distress disorders. Aim of this study was to study the association between fear and distress disorders with subsequent heart disease, taking into account the temporal order of disorders. METHODS: Twenty household surveys were conducted in 18 countries (n=53791; person years=2,212,430). The Composite International Diagnostic Interview assessed lifetime prevalence and age at onset of disorders, and respondents were categorized into categories based on the presence and timing of fear and distress disorders. Heart disease was indicated by self-report of physician-diagnosed heart disease or self-report of heart attack, together with year of onset. Survival analyses estimated associations between disorder categories and heart disease. RESULTS: Most respondents with fear or distress disorders had either pure distress or pure fear (8.5% and 7.7% of total sample), while fear preceded distress in the large majority of respondents with comorbid fear and distress (3.8% of total sample). Compared to the "no fear or distress disorder" category, respondents with pure fear disorder had the highest odds of subsequent heart disease (OR:1.8; 95%CI:1.5-2.2; p<0.001) and compared to respondents with pure distress disorder, these respondents were at a significantly increased risk of heart disease (OR:1.3; 95%CI:1.0-1.6; p=0.020). CONCLUSION: This novel analytic approach indicates that the risk of subsequent self-reported heart disease associated with pure fear disorder is significantly larger than the risk associated with distress disorder. These results should be confirmed in prospective studies using objective measures of heart disease.
OBJECTIVE: Few studies have been able to contrast associations of anxiety and depression with heart disease. These disorders can be grouped in fear and distress disorders. Aim of this study was to study the association between fear and distress disorders with subsequent heart disease, taking into account the temporal order of disorders. METHODS: Twenty household surveys were conducted in 18 countries (n=53791; person years=2,212,430). The Composite International Diagnostic Interview assessed lifetime prevalence and age at onset of disorders, and respondents were categorized into categories based on the presence and timing of fear and distress disorders. Heart disease was indicated by self-report of physician-diagnosed heart disease or self-report of heart attack, together with year of onset. Survival analyses estimated associations between disorder categories and heart disease. RESULTS: Most respondents with fear or distress disorders had either pure distress or pure fear (8.5% and 7.7% of total sample), while fear preceded distress in the large majority of respondents with comorbid fear and distress (3.8% of total sample). Compared to the "no fear or distress disorder" category, respondents with pure fear disorder had the highest odds of subsequent heart disease (OR:1.8; 95%CI:1.5-2.2; p<0.001) and compared to respondents with pure distress disorder, these respondents were at a significantly increased risk of heart disease (OR:1.3; 95%CI:1.0-1.6; p=0.020). CONCLUSION: This novel analytic approach indicates that the risk of subsequent self-reported heart disease associated with pure fear disorder is significantly larger than the risk associated with distress disorder. These results should be confirmed in prospective studies using objective measures of heart disease.
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