title: Psychological distress, physical illness, and risk of coronary heart disease.
abstract: OBJECTIVE
  The aims of this study are to confirm the association between psychological distress and coronary heart disease (CHD) using an epidemiological community study with hospital admissions data and to examine if any association is explained by existing illness.
  
  
  METHODS
  Prospective cohort study modelling the association between psychological distress, measured using the 30 item general health questionnaire (GHQ), and hospital admissions data for CHD (ICD 410-414), using proportional hazards modelling adjusted for sociodemographic, CHD risk factors, and angina, bronchitis, diabetes, ischaemia, and stroke.
  
  
  METHODS
  Two suburbs of Glasgow, Renfrew and Paisley, in Scotland.
  
  
  METHODS
  6575 men and women aged 45-64 years from Paisley.
  
  
  RESULTS
  Five year CHD risk in distressed men compared with non-distressed men was 1.78 (95% confidence intervals (CI), 1.15 to 2.75) in age adjusted analysis, 1.78 (95% CI, 1.14 to 2.79) with sociodemographic and CHD risk factor adjustment, and 1.61 (95% CI 1.02 to 2.55) with additional adjustment for existing illness. Psychological distress was unrelated to five year CHD risk in women. In further analysis, compared with healthy, non-distressed men, distressed physically ill men had a greater risk of CHD than non-distressed physically ill men, a relative risk of 4.01 (95% CI 2.42 to 6.66) compared with 2.12 (95% CI 1.35 to 3.32).
  
  
  CONCLUSIONS
  The association of psychological distress with an increased risk of five year CHD risk in men could be a function of baseline physical illness but an effect independent of physical illness cannot be ruled out. Its presence among physically ill men greatly increases CHD risk.
authors.affiliation: Department of Psychiatry, Institute of Community Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Mile End Road, London E1 4NS, UK. F.R.Rasul@qmul.ac.uk
authors.forename: F
authors.initials: F
authors.lastname: Rasul
authors.forename: S A
authors.initials: SA
authors.lastname: Stansfeld
authors.forename: C L
authors.initials: CL
authors.lastname: Hart
authors.forename: G
authors.initials: G
authors.lastname: Davey Smith
mesh_terms: D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011594:Psychometrics; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology