Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study
Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study
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DOI：
10.1093/ije/31.1.248
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发表时间：
2002-02-01
影响因子：
7.7
通讯作者：
Marmot, MG
中科院分区：
文献类型：
--
作者：
Stansfeld, SA;Fuhrer, R;Marmot, MG
背景精神障碍和心理困扰日益被认为是冠心病的危险因素。阐明这些关联的机制对预防具有重要意义。本研究旨在确认心理困扰与冠心病之间的关系，并检验是否可以通过健康行为、社会隔离和工作中的低控制力等其他因素来解释这种关联。方法对伦敦公务员进行前瞻性职业队列研究(白厅H研究)，收集1985-1988年的基线数据，并进行5年的跟踪调查。参与者是在20个政府部门工作的男女中年公务员；73%的合资格雇员参加了基线筛选。结果在男性中，在调整了年龄、工作级别和随访时间后，基线心理困扰与总体自报冠心病(优势比[OR]=1.83，95%CI：1.5~2.3)和心电图异常(OR=1.51，95%CI：1.1~2.1)的发生率增加相关。在女性中，基线心理困扰也与CHD发病率的增加有关(OR=1.60，95%CI：1.2-2。1)，但不伴有心电图异常。对健康行为、婚姻状况、社会网络和工作特征的调整使男性发生冠心病的风险降低12%，女性降低10%；对于心电图异常，这些调整使男性发生冠心病的风险增加16%，而对女性影响不大。结论心理困扰的经历增加了男性患冠心病的风险，这不是健康行为、社会孤立或工作特征所能解释的。与心理困扰相关的冠心病风险增加并不总是在女性身上表现出来。
Background Psychiatric disorder and psychological distress are increasingly recognized as risk factors for coronary heart disease (CHD). Elucidation of the mechanisms of these associations has implications for prevention. This study aims to confirm the association between psychological distress and CHD and examine if it could be explained by other factors such as health behaviours, social isolation and low control at work.Methods A prospective occupational cohort study of London-based civil service employees (Whitehall H Study) with baseline data collected from 1985-1988 with a 5-year follow-up. The participants were male and female middle-aged civil servants working in 20 Government Departments; 73% of eligible employees attended baseline screening. Psychological distress measured by the General Health Questionnaire (GHQ) at baseline was used to predict incidence of self-reported CHD and possible and probable electrocardiographic (ECG) abnormalities during follow-up.Results In men, baseline psychological distress was associated with an increased incidence 0 of overall self-reported CHD (odds ratios [OR] = 1.83, 95% CI : 1.5-2.3) and ECG abnormalities (OR = 1.51, 95% CI : 1.1-2.1), after adjustment for age, employment grade and length of follow-up. In women, baseline psychological distress was also associated with an increased incidence of CHD (OR = 1.60, 95% CI: 1.2-2. 1), but not with ECG abnormalities. Adjustment for health behaviours, marital status, social networks and work characteristics reduced the risks for incident CHD by 12% in men and by 10% in women; for ECG abnormalities these adjustments increased the risk in men by 16% and had little effect in women.Conclusions The experience of psychological distress confers increased risk of CHD in men that is not explained by health behaviours, social isolation or work characteristics. The increased risk of CHD associated with psychological distress is not consistently demonstrated in women.