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


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


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.


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