Screening for psychological distress may be an effective way to assess a patient’s risk of cardiovascular disease, a new study shows. Additionally, the researchers note, the screening process can be easy, even for healthcare providers without significant psychological training, and efficient.
In a meta-analysis that included more than 600,000 patients in 28 studies, researchers determined that psychological distress assessed with brief questionnaires was associated with almost a 30% increased risk of cardiovascular disease. Their results were published Monday, November 7, in the Journal of Cardiopulmonary Rehabilitation and Prevention .
Study co-author Carly Goldstein, an assistant professor of psychiatry and human behavior (research) at the Warren Alpert Medical School of Brown University, said the results indicate that doctors can provide a brief mental health questionnaire to a patient. during a visit and, based on self-reported responses, get a better idea of not only that patient’s mental health risks, but also their associated risk for cardiovascular disease.
The doctor may then choose to make recommendations to the patient about how to improve their mental health to help them improve their cardiovascular health, Goldstein said.
“This analysis shows that a patient’s psychological distress is directly associated with their cardiovascular risk , providing opportunities for doctors to help a patient manage their risks over time, for better overall health, right at the same time. point of attention,” Goldstein said.
Extensive evidence shows that psychological distress, including elevated symptoms of depression, anxiety, post-traumatic stress disorder, and psychosocial stress, is associated with the risk of cardiovascular disease. However, Goldstein said, there was no practical application of this information for doctors. Furthermore, he added, it was unknown whether a brief assessment of psychological distress was sufficient to predict cardiovascular disease risk.
Most research connecting psychological health and cardiovascular disease has focused on people who have already been diagnosed with cardiovascular disease, said study co-author Allison Gaffey, a clinical psychologist in the Department of Internal Medicine at the Yale School of Medicine, who completed his predoctoral internship at Brown’s medical school.
“We certainly know that psychological health is important within the scope of care management,” Gaffey said. He said far fewer studies have been devoted to understanding how psychological health among those who have not yet received a diagnosis may portend cardiovascular risks over time.
To look for associations among the general public, the researchers searched three large databases for studies that included adults without a previous psychiatric diagnosis who were screened for depression, anxiety, post-traumatic stress disorder, stress, or general mental health symptoms, and were followed for more than six months to determine their risk of cardiovascular disease. They only included research published in the last five years. The analysis included 658,331 participants, 58% of whom were women.
The meta-analysis determined that psychological distress assessed with brief assessments was indeed associated with cardiovascular disease: Researchers found that participants who reported high psychological distress showed a 28% increased risk of cardiovascular disease compared to those with little or no distress. she.
The screening tests in the studies analyzed were brief and well-known, and therefore could be administered with confidence by any clinical provider , Gaffey said.
“We believe that the use of these brief screeners, whether in a hospital or community healthcare setting, provides useful information for understanding cardiovascular disease risk in a very multidimensional way compared to the use of more standard assessments, such as blood pressure or cholesterol levels. " she said. "Even without necessarily meeting the criteria for, say, high psychological distress, those patients who show any psychological distress may still benefit from additional clinical support to help prevent cardiovascular disease."
The findings follow updated American Heart Association guidelines that expand the checklist of health and lifestyle factors for optimal cardiovascular health. The researchers noted that while "healthy sleep" was added as an essential aspect of good heart health, "stress management and mental health" were not added.
"There is a strong amount of evidence indicating that people who are in high psychological distress tend to be worse off with the other factors on the checklist," said co-author Emily Gathright, an assistant professor of psychiatry and human behavior at the School of Medicine. Warren Alpert.. “Our study is part of accumulating evidence that psychological distress is a really important factor in a cardiovascular diagnosis, like other health behaviors and risk factors, such as physical activity and cholesterol levels, that doctors monitor.”
In other words, the researchers said, the checklist needs to be expanded to include good mental health.
Goldstein noted that in the studies the researchers looked at in their analysis, the most common domain of psychological distress assessed was depression. Because anxiety also contributes to psychological distress and can even manifest in ways other than depression, he suggested that screeners used in clinical practice include ways to fully assess anxiety and depression.
All three psychology researchers work in cardiac rehabilitation, Goldstein said, and therefore are familiar with how psychological health support supports cardiovascular health.
“I would encourage all providers, cardiovascular and specialty providers, as well as primary care providers, to perform some type of brief psychological distress assessment to assess cardiovascular risk,” Goldstein said. “And I would say that each provider’s office can make brief recommendations to patients that warrant them, which can be as simple as pointing out free, publicly available mental health resources.”
Just as the assessment process can be brief and efficient, Goldstein added, so can mental health support recommendations, and both can make a difference in a patient’s overall health.
Lauren Fletcher, medical education and clinical engagement librarian at Brown University, also contributed to this research.
Conclusions: Rapid screening for psychological disorders is a useful and efficient approach to understanding an individual’s CVD risk profile. Additional research is needed to improve prospective evidence on psychosocial stress. Conducting analyzes by sex may better elucidate the benefits of screening for psychological disorders for men and women, respectively, and encourage more widespread adoption in CVD prevention. |
