Associations between mental disorders and subsequent onset of hypertension

Abstract

Background

Previous work has suggested significant associations between various psychological symptoms (e.g., depression, anxiety, anger, alcohol abuse) and hypertension. However, the presence and extent of associations between common mental disorders and subsequent adult onset of hypertension remain unclear. Further, there are few data available on how such associations vary by gender or over life course.

Methods

Data from the World Mental Health Surveys (comprising 19 countries and 52,095 adults) were used. Survival analyses estimated associations between first onset of common mental disorders and subsequent onset of hypertension, with and without psychiatric comorbidity adjustment. Variations in the strength of associations by gender and by life course stage of onset of both the mental disorder and hypertension were investigated.

Results

After psychiatric comorbidity adjustment, depression, panic disorder, social phobia, specific phobia, binge eating disorder, bulimia nervosa, alcohol abuse and drug abuse were significantly associated with subsequent diagnosis of hypertension (with odds ratios ranging from 1.1 to 1.6). Number of lifetime mental disorders was associated with subsequent hypertension in a dose–response fashion. For social phobia and alcohol abuse, associations with hypertension were stronger for males than females. For panic disorder, the association with hypertension was particularly apparent in earlier-onset hypertension.

Conclusions

Depression, anxiety, impulsive eating disorders and substance use disorders were significantly associated with the subsequent diagnosis of hypertension. These data underscore the importance of early detection of mental disorders, and of physical health monitoring in people with these conditions.

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.