Associations between DSM-IV mental disorders and subsequent heart disease onset: Beyond depression

Kate M. Scott, Peter De Jonge, Jordi Alonso, Maria Carmen Viana, Zhaorui Liu, Siobhan O'Neill, Sergio Aguilar-Gaxiola, Ronny Bruffaerts, Jose Miguel Caldas-De-Almeida, Dan J. Stein, Giovanni De Girolamo, Silvia E. Florescu, Chiyi Hu, Nezar Ismet Taib, Jean Pierre Lépine, Daphna Levinson, Herbert Matschinger, Maria Elena Medina-Mora, Marina Piazza, José A. Posada-VillaHidenori Uda, Bogdan J. Wojtyniak, Carmen C.W. Lim, Ronald C. Kessler

Research output: Contribution to journalArticlepeer-review

68 Scopus citations


Background Prior studies on the depression-heart disease association have not usually used diagnostic measures of depression, or taken other mental disorders into consideration. As a result, it is not clear whether the association between depression and heart disease onset reflects a specific association, or the comorbidity between depression and other mental disorders. Additionally, the relative magnitude of associations of a range of mental disorders with heart disease onset is unknown. Methods Face-to-face household surveys were conducted in 19 countries (n = 52,095; person years = 2,141,194). The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Heart disease was indicated by self-report of physician's diagnosis, or self-report of heart attack, together with their timing (year). Survival analyses estimated associations between first onset of mental disorders and subsequent heart disease onset. Results After comorbidity adjustment, depression, panic disorder, specific phobia, post-traumatic stress disorder and alcohol use disorders were associated with heart disease onset (ORs 1.3-1.6). Increasing number of mental disorders was associated with heart disease in a dose-response fashion. Mood disorders and alcohol abuse were more strongly associated with earlier onset than later onset heart disease. Associations did not vary by gender. Conclusions Depression, anxiety and alcohol use disorders were significantly associated with heart disease onset; depression was the weakest predictor. If confirmed in future prospective studies, the breadth of psychopathology's links with heart disease onset has substantial clinical and public health implications.

Original languageEnglish
Pages (from-to)5293-5299
Number of pages7
JournalInternational Journal of Cardiology
Issue number6
StatePublished - 15 Oct 2013
Externally publishedYes


  • Alcohol abuse
  • Anxiety disorders
  • Comorbidity
  • Depression
  • Heart disease


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