Mental Disorders and Coronary Heart Disease Risk: Could the Evidence Elude Us While We Sleep?
Although provocative findings from large epidemiological studies suggest that mental disorders and elevated psychiatric symptoms are independent risk factors for the incidence and recurrence of coronary heart disease (CHD), other studies do not replicate this somewhat startling finding.1–3 This research has been characterized by incomplete adjustment for confounders, wide variation in the assessment of mental disorders, and inconsistent inclusion of multiple mental disorders and overlapping symptom clusters. For incident CHD, the most convincing evidence comes from prospective studies linking a diagnosis of depression or the presence of elevated depressive symptoms with later occult CHD.3 Although there have been tantalizing glimpses of associations of other types of mental disorders, such as alcohol/substance use disorder, anxiety, and schizophrenia, with incident CHD, there are a paucity of studies examining this risk. Indeed, we conducted a preliminary search of the prospective epidemiological literature on the association of mental disorders with incident CHD and found that, of 123 results retrieved, approximately 60% focused uniquely on depression, 10% on alcohol/substance use disorder, 11% on anxiety or posttraumatic stress disorder, and 14% on psychosis or schizophrenia. Thus, outstanding questions about the nature and consistency of the association of specific types of mental disorders—other than depression—and incident CHD remain.
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