Mental distress increases risk of heart disease in diabetics

Aug 30 2004

Even without the burden of psychological distress, people with diabetes are already more vulnerable to cardiovascular disease. Compared to those without the disease, deaths from heart disease are more than twice as high in men with diabetes and almost three times as high in women - making it particularly important to reduce the impact of psychological distress, according to the study.

“Mental health professionals need to be involved in the care of diabetic persons,” says study author Tara W. Strine, M.P.H., an epidemiologist in the Division of Adult and Community Health at the Centers for Disease Control and Prevention. The findings appear in the American Journal of Health Behavior.

Strine and colleagues studied survey results from 4,241 people with diabetes, part of the Behavioral Risk Factors Surveillance System, a telephone survey of U.S. adults. Nearly 13 percent of these individuals reported frequent mental distress — defined as experiencing stress, depression or emotional problems for 14 of the past 30 days.

Mentally distressed people with diabetes were significantly more likely than non-distressed diabetic people to smoke (18.5 percent versus 12.7 percent), have high cholesterol (50.8 percent versus 41.7 percent) and high blood pressure (63.4 percent versus 54.2 percent). They were also more likely to avoid exercise such as running, calisthenics, golf, gardening or walking (44.1 percent versus 35.4 percent).

Distressed people with diabetes were also more likely to experience four or more of five risk factors examined, the researchers found. The most common risk factor cluster, experienced by approximately 41 percent of this group, was the combination of obesity, exercise avoidance, high blood pressure and high cholesterol.

Other researchers have found that individuals with mood disorders such as depression and anxiety have a rougher time adhering to health care regimens due to impaired focus and reduced energy and motivation levels. Such insights may help explain the current study findings.

“The management of diabetes is multi-faceted, complex and demanding,” Strine says. “It depends primarily on the diabetic person’s self-care behavior.”

Despite the association between depression and cardiovascular disease, and despite the higher health care costs associated with the pairing of these two disorders, only a third of depressed diabetics receive treatment for depression, according to previous research.

The authors note that limitations of this study included its exclusion of severely physically or mentally impaired individuals, as well as those without telephone access. Also, while this type of study may suggest an association between mental distress and heart disease risk factors, it cannot determine the exact mechanism behind this association.