Race and Ethnic Differences in the Associations between Cardiovascular Diseases, Anxiety, and Depression in the United States

Authors

1 Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, USA

2 Center for Research on Ethnicity, Culture and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, USA

3 Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, USA

Abstract

Introduction: Although cardiovascular diseases and psychiatric disorders are linked, it is not yet known if such links are independent of comorbid medical diseases and if these associations depend on race and ethnicity. This study aimed to determine if the associations between cardiovascular diseases with general anxiety disorder (GAD) and major depressive episode (MDE) are independent of comorbid medical diseases and if these links differ among African Americans, Caribbean Blacks, and Non-Hispanic Whites.

Methods: This cross-sectional study enrolled African American, Caribbean Black, and Non-Hispanic White adults who had participated in the National Survey of American Life (NSAL), 2001 - 2003. Data on socio-economics (age, sex, and education level) were collected. Self-reported physician diagnosed cardiovascular diseases (heart disease, atherosclerosis, hypertension, and stroke) and chronic medical conditions (peptic ulcer, cancer, diabetes, liver disease, kidney disease, asthma, other chronic respiratory diseases, sickle cell anemia, and glaucoma) were measured. The 12-month GAD and MDE were measured using the Composite International Diagnostic Interview (CIDI). Logistic regressions were fitted to data to determine if the associations between cardiovascular diseases and 12-month GAD and 12-month MDE are independent of socio-economic status and comorbid chronic medical diseases across race and ethnic groups.

Results: Above and beyond other medical conditions, heart disease and atherosclerosis were associated with 12-month GAD among Caribbean Blacks, but not African Americans or non-Hispanic Whites. Hypertension was associated with 12-month MDE among African Americans, and heart disease was associated with 12-month MDE among Caribbean Blacks. None of the cardiovascular diseases were associated with 12-month MDE among non-Hispanic Whites, while all the other medical conditions were controlled.

Conclusion: Our study showed race and ethnicity may be associated with specific patterns of comorbidity between cardiovascular diseases and 12-month MDE and GAD. By other words, the link between psychiatric disorders and cardiovascular diseases may depend on race and ethnicity. More research is needed to explore the behavioral and mental health profile of individuals with heart disease based on race and ethnicity. Race and ethnicity should inform mental health evaluation of patients with cardiovascular diseases.

Keywords

References

  1. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al., Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933-44.
  2. Steinwachs DM, Collins-Nakai RL, Cohn LH, Garson A Jr, Wolk MJ. The future of cardiology: utilization and costs of care. J Am Coll Cardiol. 2000;35(suppl B):91B-8.
  3. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009.  Natl Vital Stat Rep. 2011;60(3):1-116.
  4. Trogdon JG, Finkelstein EA, Nwaise IA, Tangka FK, Orenstein D. The economic burden of chronic cardiovascular disease for major insurers. Health Promot Pract. 2007;8:234-42.
  5. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association [published correction appears in Circulation. 2010;121:e260]. Circulation. 2010; 121:e46-e215.
  6. Cohen JW, Krauss NA. Spending and service use among people with the fifteen most costly medical conditions, 1997. Health Aff (Millwood). 2003;22:129-38.
  7. Roehrig C, Miller G, Lake C, Bryant J. National health spending by medical condition, 1996–2005. Health Aff (Millwood). 2009;28:w358-67.
  8. Frasure-Smith N, Lespérance F. Recent evidence linking coronary heart disease and depression. Can J Psychiatry. 2006;51:730-7.
  9. Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005 Mar;131(2):260-300.
  10. May HT, Horne BD, Carlquist JF, Sheng X, Joy E, Catinella AP. Depression after coronary artery disease is associated with heart failure. J Am Coll Cardiol. 2009;53:1440-7.
  11. Whang W, Kubzansky LD, Kawachi I, et al.Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses’ Health Study. J Am Coll Cardiol. 2009;53:950–8.
  12. Krantz DS, Whittaker KS, Francis JL, Krantz DS, Whittaker KS, Francis JL, et al. Psychotropic medication use and risk of adverse cardiovascular events in women with suspected coronary artery disease: outcomes from the Women’s Ischemia Syndrome Evaluation (WISE) study. Heart. 2009;95:1901-6.
  13. Bayat N, Alishiri GH, Salimzadeh A, Izadi M, Kazemi Saleh D, Moghani Lankarani M, Assari S Symptoms of anxiety and depression: A comparison among patients with different chronic conditions J Res Med Sci. 2011;16(11):1441-7
  14. Sprangers MA, de Regt EB, Andries F, van Agt HM, Bijl RV, de Boer JB, Foets M, Hoeymans N, Jacobs AE, Kempen GI, Miedema HS, Tijhuis MA, de Haes HC. Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol. 2000 Sep;53(9):895-907.
  15. Fisher L, Laurencin G, Chesla CA, Skaff MM, Mullan JT, Gardiner PS, Chun KM. Depressive affect among four with type 2 diabetes. Diabetes Spectrum. 2004;17(4):215-24.
  16. Ferraro KF, Farmer M. Double Jeopardy in Health Hypothesis for African Americans: Analysis and Critique. J Health Social Behavior. 1996;51B(6):S319-28
  17. Haarasilta L, Marttunen M, Kaprio J, Aro H. Major depressive episode and health care use among adolescents and young adults. Soc Psychiatry Psychiatr Epidemiol. 2003;38(7):366-8.
  18. Levenson JL. Psychosocial interventions in chronic medical illness. An overview of outcome research. Gen Hosp Psychiatry. 1992; 14(6 Suppl):43S-9S.
  19. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370:851-8.
  20. Gladis MM, Gosch EA, Dishuk NM, Crits-Christoph P. Quality of life: expanding the scope of clinical significance. J Consult Clin Psychol. 1999;67(3):320-31.
  21. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000; 160(14):2101-7.
  22. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, et al. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989;262(7):914-9.
  23. Jackson JS, Neighbors HW, Nesse RM, Trierweiler SJ, Torres M. Methodological innovations in the National Survey of American Life. Int J Methods in Psych Res. 2004;13:289-98.
  24. Jackson JS, Torres M, Caldwell CH, Neighbors HW, Nesse RM, Taylor RJ, et al. The National Survey of American Life: A study of racial, ethnic, and cultural influences on mental disorders and mental health.  Int J Methods in Psych Res. 2004:13:196-207.
  25. Heeringa S, Wagner J, Torres M, Duan NH, Adams T, Berglund P. Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES). Int J Methods in Psych Res. 2004;13;221-40.
  26. Interuniversity Consortium for Political and Social Research (ICPSR). National Study of American Life (NSAL) sample design, 2013. Available at: http://www.icpsr.umich.edu/icpsrweb/CPES/about_cpes/sample_design.jsp
  27. Kessler, RC, Andrews, G, Mroczek, D, Ustun, B, Wittchen, H. The World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF). Int J Methods in Psych Res, 1998:7:171-85.
  28. Spruill TM, Gerber LM, Schwartz JE, Pickering TG, Ogedegbe G. Race Differences in the Physical and Psychological Impact of Hypertension Labeling. Am J Hypertens. 2012 Jan 19. doi: 10.1038/ajh.2011.258.
  29. Melamed S, Froom P, Green MS. Hypertension and sickness absence: the role of perceived symptoms. J Behav Med. 1997;20:473-87.
  30. Baumann LJ, Cameron LD, Zimmerman RS, Leventhal H. Illness representations and matching labels with symptoms. Health Psychol. 1989;8:449–69. 
  31. Pickering TG. Now we are sick: labeling and hypertension. J Clin Hypertens (Greenwich). 2006;8:57–60.
  32. Segerstrom SC, Miller GE. Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychol Bullet. 2004;130(4):601-30.
  33. Player MS, Peterson LE. Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med. 2011;41(4):365-77.
  34. Van der Kooy K, Van Hout H, Marwijk H, Marten H, Stehouwer C, Beekman A. Depression and the risk for cardiovascular diseases: systematic review and meta-analysis. Int J Geriatr Psychiatry. 2007 Jul;22(7):613-26.
  35. Ferraro KF, Farmer M. Double Jeopardy in Health Hypothesis for African Americans: Analysis and Critique. J Health Social Behavior. 1996;51B (6);S319-28.
  36. Anderson GM, Grumbach K, Loft HS, Roos LL, Mustard C,  Brook R. Use of Coronary Artery Bypass Surgery in the United States. Journal of the American Medical Association. 1993;269:1661-6.
  37. Ayanian JZ, Udvarhelyi IS, Gatsonis CA, Pashos CL, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography.. JAMA; 1993;269(20):2642-46.
  38. Gillum, RF. Coronary Artery Bypass Surgery and Coronary Angiography in the United States, 1979-1983. Am Heart J. 1987;113:1255-60.
  39. Wee HL, Li SC, Cheung YB, Fong KY, Thumboo J. The influence of ethnicity on health-related quality of life in diabetes mellitus: a population-based, multiethnic study. J Diabetes Complications. 2006;20(3):170-8.
  40. Smoller JW, Allison M, Cochrane BB, Curb JD, Perlis RH, Robinson JG, et al. Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women's Health Initiative study. Arch Intern Med. 2009; 169(22):2128-39.
  41. Barrick CB. Sad, glad, or mad hearts? Epidemiological evidence for a causal relationship between mood disorders and coronary artery disease. J Affect Disord. 1999;53:193-201.
  42. Appels A. Depression and coronary heart disease: observations and questions. J Psychosom Res. 1997;43:443-52.
  43. González HM, Tarraf W. Comorbid cardiovascular disease and major depression among ethnic and racial groups in the United States.  Int Psychogeriatr. 2013 May;25(5):833-41.
  44. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med. 2004;66:802–13.
  45. van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, van Veldhuisen DJ, van den Brink RH, van den Berg MP. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med. 2004;66: 814-22.
  46. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27:2763-74.
  47.  Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta- analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48:1527–37.
  48. Rugulies R. Depression as a predictor for coronary heart disease: a review and meta-analysis. Am J Prev Med. 2002;23:51-61.
  49. Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med. 2003;65:201-10.
  50. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease. Am J Psychiatry. 1998;155:4-11.
  51. Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry. 1998;55:580-92.
  52. Hemingway H, Marmot M. Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies. BMJ. 1999;318:1460–7.
  53. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99:2192-217.
  54. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer, 1984.
  55. Lazarus, R. S. Theory-based stress measurement. Psychological Inquiry. 1990;1(1),3-13.
  56. Dohrenwend BS, Dohrenwend BP. Stressful life events: Their nature and effects. Oxford, England: Wiley, 1974.
  57. Kressin NR, Wang F, Long J, Bokhour BG, Orner MB, Rothendler J, Clark C, Reddy S, Kozak W, Kroupa LP, Berlowitz DR. Hypertensive patients' race, health beliefs, process of care, and medication adherence. J Gen Intern Med. 2007;22:768-74. 
  58. Okonofua EC, Cutler NE, Lackland DT, Egan BM. Ethnic differences in older Americans: awareness, knowledge, and beliefs about hypertension. Am J Hypertens. 2005;18:972-9. 
  59. Juergens MC, Seekatz B, Moosdorf RG, Petrie KJ, Rief W. Illness beliefs before cardiac surgery predict disability, quality of life, and depression 3 months later. J Psychosom Res. 2010;68:553–60. 
  60. Livingston IL. (Ed.). Handbook of Black American Health: The Mosaic of Conditions, Issues, Policies, and Prospects. Westport, CT: Greenwood Press. 1994.
  61. U.S. Department of Health and Human Services. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: U.S. Government Printing Office, 1991.
  62. Wolinsky FD, Aguirre BE, Fann L, Keith VM, Arnold CL, Niederhauer JC, Dietrich K. Ethnic Differences in the Demand for Physician and Hospital Utilization among Older Adults in Major American Cities: Conspicuous Evidence of Considerable Inequalities. Milbank Quarterly. 1989;67:412-449.
  63. Williams DR, González HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, Jackson JS. Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64(3):305-15.
  64. Jackson JS, Knight KM, Rafferty JA. Race and unhealthy behaviors: chronic stress, the HPA axis, and physical and mental health disparities over the life course. Am J Public Health. 2010;100(5):933-9.
  65. Schulz A, Israel B, Williams D, Parker E, Becker A, James S. Social inequalities, stressors and self reported health status among African American and White women in the Detroit metropolitan area. Soc Sci Med. 2000;51:1639-53.
  66. Williams DR. Racial/ethnic variations in women’s health: The social embeddedness of health. Am J Public Health. 2002;92(4):588-97.
  67. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93(2):200-8.
  68. Koopmans GT, Lamers LM. Chronic conditions, psychological distress and the use of psychoactive medications. J Psychosom Res. 2000;48(2):115-23.
  69. Morenoff JD, House JS, Hansen BB, Williams DR, Kaplan GA, Hunte HE. Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context. Soc Sci Med. 2007;65:1853–66
  70. Gibson RC. Race and the Self-Reported Health of Elderly Persons. J Gerontol: Social Science. 1991;46:S235-42.
  71. Cohen S, Herbert TB. Health psychology: Psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annu Rev Psychol. 1996;47:113-42.
  72. Palinkas LA, Wingard DL, Barrett-Connor E. Chronic illness and depressive symptoms in the elderly: a populationbased study. J Clin Epidemiol. 1990;43(11):1131-41.
  73. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069-78.
  74. Theofilou P. Depression and anxiety in patients with chronic renal failure: the effect of sociodemographic characteristics.
  75. Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res. 2002; 53(6):1053-60.
  76. Israel M. Depression in dialysis patients: a review of psychological factors. Can J Psychiatry. 1986;31(5):445-51.
  77. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psych. 2005;62:593-602.
  78. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12 month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psych. 2005;62:617-27.
  79. Takeuchi DT, Zane N, Hong S, Chae DH, Gong F, Gee GC, Walton E, Sue S, Alegria M. Immigration-related factors and mental disorder among Asian Americans. Am J Public Health. 2007;97:84-90.
  80. Assari S. Separate and combined effects of anxiety, depression and problem drinking on subjective health among black, hispanic and non-hispanic white men. Int J Prev Med. 2014;5(3):269-79. 
  81. Alegria M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G. Prevalence of psychiatric disorders across Latino subgroups in the United States.  Am J Public Health. 2007;97:68-75.
  82. Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69-101.
  83. Janszky I, Ahnve S, Lundberg I, et al. Early-onset depression, anxiety and risk of subsequent coronary heart disease. 37-year follow-up of 49,321 young Swedish men. J Am Coll Cardiol. 2010;56:31-7.
  84. Assari S. Additive Effects of Anxiety and Depression on Body Mass Index among Blacks: Role of Ethnicity and Gender. Int Cardiovasc Res J. 2014;8(2):44-51. 
  85. Assari S. Chronic medical conditions and major depressive disorder: differential role of positive religious coping among African Americans, Caribbean blacks and non-hispanic whites. Int J Prev Med. 2014;5(4):405-13.
  86. Assari S, Lankarani MM, Lankarani RM. Ethnicity modifies the additive effects of anxiety and drug use disorders on suicidal ideation among black adults in the United States. Int J Prev Med. 2013;4(11):1251-7.
  87. Assari S. Race and Ethnicity, Religion Involvement, Church-based Social Support and Subjective Health in United States: A Case of Moderated Mediation. Int J Prev Med. 2013;4(2):208-17.
  88. Assari, S. Association between obesity and depression among American Blacks: Role of ethnicity and gender. Journal of Racial and Ethnic Health Disparities. 2014;1(1):36-44.
  89. Assari S. Synergistic Effects of Lifetime Psychiatric Disorders on Suicidal Ideation Among Blacks in the USA. Journal Racial Ethnic Health Disparities 2014: 1-8.
  90. Assari S. The link between mental health and obesity: role of individual and contextual factors. Int J Prev Med. 2014;5(3):247-9.
  91. Assari S1, Lankarani RM, Lankarani MM. Cross-country differences in the association between diabetes and disability. J Diabetes Metab Disord. 2014 6;13(1):3.
  92. Assari S. Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes. J Diabetes Metab Disord. 2014;13(1):36.
International Journal of Travel Medicine and Global Health
Volume 2, Issue 3 - Serial Number 6
September 2014
Pages 107-113

Files

History

  • Receive Date: 10 August 2014
  • Revise Date: 21 August 2014
  • Accept Date: 29 August 2014

Share

How to cite

Statistics