Psychological Distress and Socioeconomic Status Can Affect Risk for Chronic Diseases

Catharine Gale, BSc, PhD

The risk for chronic obstructive pulmonary disease (COPD), arthritis, and cardiovascular disease can be increased by patient’s psychological distress, even if their distress is considered low or moderate, according to a recent study.

“Psychological distress” is a term that encompasses a wide range of anxiety and depression symptoms, from mild to severe. The authors say these symptoms have been associated with an increased risk of many chronic health conditions, as well as with all-cause mortality.

Author Catharine Gale, BSc, PhD, a professor of cognitive epidemiology in the MRC Lifecourse Epidemiology Unit at the University of Southampton, at Southampton General Hospital told MD Magazine, “Our findings show that even low levels of psychological distress, below the level usually considered clinically significant, appear to increase the risk of arthritis, chronic lung disease, and cardiovascular disease.”

Gale and her colleagues set out to assess the links between psychological distress and socioeconomic position for 4 diseases: diabetes, arthritis, COPD, and cardiovascular disease. They selected these 4 particular conditions to study because while the association with “significant distress” and these diseases has been well established, the evidence of their connection to subclinical distress levels demonstrated “a significant gap in knowledge.”

They also took into account the severity of the patient’s distress, health habits that would affect risk (e.g., diet, exercise, smoking), and variations based on socioeconomic status.

The study collected data from 16,485 adults who had participated in the UK Household Longitudinal Study, which had gathered data on economic, social, psychological, and health from a large sample of participants from various social, economic, and ethnic backgrounds.

In this study, patients’ baseline psychological distress was reported on the General Health Questionnaire (GHQ), and they self-reported their experience with the four disorders over the past 3 years. The GHQ asks users to rate the frequency of their experience with 12 common symptoms, including loss of confidence and sleep disruptions. The study was also designed to control for age, sex, body mass index, baseline disease, and social support, including marital status and neighborhood cohesion.

The participants’ socioeconomic position was based on occupation, including most recent occupation if the participant was not employed. They were categorized using the Registrar General’s Social Class, which ranges from “professional occupation” to “unskilled occupation.” The participants were then further divided into “non-manual” and “manual” occupational classes.

The authors concluded that there was a dose-response pattern of psychological distress associated with significantly increased risk for COPD, cardiovascular disease, and arthritis. Patients with high distress levels—in this case, a score of 7 or higher on the GHQ—were said to be at an increased risk for COPD (odds ratio [OR], 3.25; 95% CI, 1.47 to 7.18), and cardiovascular disease (OR 3.06; 95% CI, 1.89 to 4.98) arthritis (OR 2.22; 95% CI, 1.58 to 2.13). Participants’ smoking status affected the association, but it remained significant after accounting for smoking, as well as exercise and eating habits.

“This implies that interventions to reduce symptoms of anxiety and depression may help to prevent these diseases,” Gale said.

The risk for diabetes was increased significantly only for participants in the “manual” occupational group, as opposed to “non-manual.” The authors did not report any socioeconomic effect on risk for arthritis, COPD, or cardiovascular disease.

The study, The effects of psychological distress and its interaction with socioeconomic position on risk of developing four chronic diseases, was published in Journal of Psychosomatic Research.