Nicholson, Amanda Claire; (2003) Psychological distress as a predictor of coronary heart disease. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Depressive features have emerged, from the arena of psychosocial determinants, as potentially important coronary heart disease risk factors. Despite a large literature, uncertainty remains concerning both the independence of the effect of depression from that of other psychosocial variables, and the pathophysiological mechanism underlying the association. Using data from the Whitehall II study, the relationship between psychological distress (measured by the GHQ-30) and future CHD events has been examined in men, with attention paid to the effect of the persistence of distress. Psychological distress was found to predict future CHD, with some evidence that the association was stronger for transient distress. Analyses using factors of the GHQ-30 did not suggest that depressive features were associated with CHD risk, whereas anxiety items and sleep questions were found to be the strongest predictors of future events. The effect of distress was found to be independent of other psychosocial risk factors, such as employment grade, hostility and life events. The role of health behaviours, other conventional CHD risk factors, inflammatory variables and components of the metabolic syndrome, in the association between distress and CHD was examined. The results did not support a mediating role for these variables. Potentially important differences emerged between transient and more chronic distress. The effect of transient distress on future CHD events was greater in men with evidence of underlying CHD, suggesting an acceleration role for distress. The effect of chronic distress was more consistent with an atherogenic role, although a pathway of action could not be identified in these data. This thesis confirms that psychological distress is a predictive risk factor for CHD, but suggests that transient and more chronic distress may be measuring different facets of psychological risk.

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