Psychiatric–Medical ComorbidityAssociations between mental disorders and subsequent onset of hypertension
Introduction
Previous work has suggested significant associations between hypertension and psychological symptoms such as depression, anxiety and anger [1], [2]. The existence of such associations would be consistent with work indicating that such symptoms are accompanied by alterations in peripheral and central neuroendocrine systems or may have a range of behavioral correlates, which may in turn have persistent adverse effects on physical health [3]. At the same time, there are few prospective data directly demonstrating a link between alterations in neurophysiology or behavior and subsequent hypertension, and it has also been suggested that being labeled as hypertensive itself leads to psychological symptoms [4].
Indeed, the presence and extent of associations between onset of common mental disorders and subsequent adult onset hypertension remain unclear. Much of the literature in this area has employed symptom screening scales, which may not discriminate well between different negative emotions, and little of the literature in this area has assessed common mental disorders [1], [2]. Much work has focused on specific psychological domains rather than on the relative contributions of a range of symptoms or disorders, and no data are available on the effects of mental disorder comorbidity on subsequent hypertension. Further, there is little if any work examining the possibility that such associations may vary by gender or over the life course.
Assessing the nature of the associations between onset of common mental disorders and subsequent hypertension is important for several reasons. First, there is ongoing neuroscientific and behavioral interest in the potential mechanisms accounting for the adverse effects of psychological symptoms and mental disorders on physical health [5], [6]. Second, given that common mental disorders are highly prevalent, often begin early in life and are treatable [7], an association between such conditions and subsequent hypertension would have important public health implications.
The cross-national World Mental Health Surveys (WMHS) provide a valuable data set for addressing questions about the presence and extent of associations between onset of common mental disorders and subsequent chronic medical conditions. In these population-based surveys, individuals from countries around the world have been assessed for lifetime history of a wide range of common mental disorders, as well as for self-reported physician’s diagnosis of chronic medical conditions including hypertension [8]. Although the surveys are cross-section in design, information on the time of onset of these conditions was collected. Here, we examine the association between temporally prior common mental disorders and subsequent onset of hypertension in countries participating in the WMHS using survival analysis methods.
Section snippets
Samples and procedures
Data are from 19 of the WMHS: Colombia, Mexico, Peru, United States, Shenzhen (China), Japan, New Zealand, Belgium, France, Germany, Italy, the Netherlands, Romania, Spain, Portugal, Israel, Iraq, Northern Ireland and Poland (Table 1). A stratified multistage clustered area probability sampling strategy was used to select adult respondents (18 years +) in most WMH countries. These surveys were based on nationally representative household samples, except for Colombia, Mexico and Shenzhen, which
Descriptive
The survey characteristics are shown in Table 1 together with information about the number of survey respondents reporting a history of hypertension (n= 8422).
Type and number of mental disorders as predictors of hypertension onset
The associations between individual mental disorders and subsequent hypertension onset were investigated in a series of bivariate models (i.e., only one mental disorder considered at a time). In the results presented in Table 2, it is apparent that all but one type of mental disorder were found to predict adult hypertension onset with odds
Discussion
Several limitations of the current study deserve emphasis. First, retrospective assessment of mental disorders may lead to underestimations of prevalence and may also be associated with inaccuracies in age of onset timing [15]. Second, there were no clinical data to validate the diagnosis of hypertension or to characterize fully its duration, severity and sequelae. Nevertheless, self-reported hypertension is moderately associated with objective data on hypertensive status [16], [17]. Estimates
Acknowledgments and Funding
The World Health Organization WMHS Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb. We thank the staff of the WMH Data
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