Single time-point assessments of distress are practical in large-scale cohort studies. 9–12 Most studies quantifying the distress–incident CVD association assess symptoms of distress once, with measures assessing symptoms in the previous 4 weeks. One limitation to the current evidence relates to the way distress is measured. 8 However, whether a direct relationship exists remains uncertain, 9 at least in part due to methodological limitations to the evidence. Multiple linking mechanisms have been proposed, including genetic pleiotropy, reverse causality, a behaviour-related (eg, poor diet) pathway and a direct relationship, potentially mediated by biological changes resulting from ongoing cognitive factors (eg, excessive worry). Reasons for the elevated rates of CVD among people with distress are currently unclear.
The incidence of ischaemic heart disease (IHD) and stroke is elevated by around 50% 5 6 and CVD mortality is elevated by 72% 7 in those with high compared with low levels of distress. 3 4 Given that symptoms of depression and anxiety commonly co-occur, they are often studied together and collectively referred to as psychological distress. 1 2 The burden of CVD is disproportionately high among people who experience symptoms of depression and anxiety. IntroductionĬardiovascular disease (CVD) is a leading contributor to fatal and non-fatal burden of disease internationally and in Australia. Our sample was restricted to participants who completed two questionnaires, and we cannot rule out that loss to follow-up biased our estimates. Using questionnaires linked to administrative data allowed for assessment of sociodemographic and health behaviours with virtually complete and objectively measured cardiovascular disease outcomes.ĭespite a large sample size, we observed small numbers of outcome events in some exposure groups, limiting the precision of our estimates. We were able to use questionnaire data collected at two time-points, allowing us to ascertain a longer-term measure of psychological distress. We used data from a large-scale prospective study of people aged 45 years and over living in the general community.
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