Behavioral factors are important in disease incidence and mortality and may explain associations between mortality and various psychological traits.
These analyses investigated the impact of behavioral factors on the associations between depression, hostility and cardiovascular disease(CVD) incidence, CVD mortality, and all-cause mortality.
Data from the PRIME Study (N = 6953 men) were analyzed using Cox proportional hazards models, following adjustment for demographic and biological CVD risk factors, and other psychological traits, including social support.
Following initial adjustment, both depression and hostility were significantly associated with both mortality outcomes (smallest SHR = 1.24, p < 0.001). Following adjustment for behavioral factors, all relationships were attenuated both when accounting for and not accounting for other psychological variables. Associations with all-cause mortality remained significant (smallest SHR = 1.14, p = 0.04). Of the behaviors included, the most significant contribution to outcomes was found for smoking, but a role was also found for fruit and vegetable intakes and high alcohol consumption.
These findings demonstrate well-known associations between depression, hostility, and mortality and suggest the potential importance of behaviors in explaining these relationships.
Haynes SG, Levine S, Scotch N, et al. The relationship of psychosocial factors to coronary heart disease in the Framingham study. Methods and risk factors. Am J Epidemiol. 1978; 107: 362-83. PubMed
Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Ann Rev Publ Health. 2005; 26: 469-500. CrossRef
Haynes SG, Feinleib M, Kannel WB. The relationship between psychosocial factors to coronary heart disease in the Framingham study. Am J Epidemiol. 1980; 111: 37-58. PubMed
Bortman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. Lancet. 2007; 370: 1089-1100. CrossRef
Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999; 99: 2912-2217. CrossRef
Thomas KS, Nielsen RA, Dimsdale JE. Relationships between hostility, anger expression and blood pressure dipping in an ethically diverse sample. Psychosom Med. 2004; 66: 298-304. PubMed
Scherwitz LW, Perkins LL, Chesney MA, Hughes GH, Sidney S, Manollo TA. Hostility and health behaviors in young adults: the CARDIA study. Am J Epidemiol. 1992; 136: 136-45. PubMed
Siegler IC, Peterson BL, Barefoot JC, Williams RB. Hostility during late adolescence predicts coronary risk factors in mid-life. Am J Epidemiol. 1992; 136: 146-154. PubMed
Ruidavets JB, Ducimetiere P, Evans A, et al. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: The Prospective Epidemiological Study of Myocardial Infarction (PRIME). BMJ. 2010; 341, e6077. CrossRef
Gallo LC, Smith TW. Patterns of hostility and social support: conceptualizing psychosocial risk factors as characteristics of the person and the environment. J Res Pers. 1999; 33: 281-310. CrossRef
The PRIME Study Group. The PRIME study: Classical risk factors do not explain the severalfold differences in risk of coronary heart disease between France and Northern Ireland. Quart J Med. 1998; 91: 667-76. CrossRef
Cook WW, Medley DM. Proposed hostility and pharisaic-virtue scales for the MMPI. J Appl Psychol. 1954; 38: 414-18. CrossRef
World Health Organization. MONICA Psychosocial Optional Study. Suggested measurement instruments. Copenhagen: WHO Regional Office for Europe; 1989.
Savica V, Bellinghieri G, Kopple JD. The effect of nutrition on blood pressure. Ann Rev Nutr. 2010; 30: 365-401. CrossRef
Hartmann-Boyce J, Johns DJ, Jebb SA, Summerbell C, Aveyard P. Behavioural Weight Management Review Group. Behavioural weight management programmes for adults assessed by trials conducted in everyday contexts: Systematic review and meta-analysis. Obes Rev. 2014; 15: 920-32. CrossRefPubMedPubMedCentral
Oyebode O, Gordon-Dseagu V, Walker A, Mindell JS. Fruit and vegetable consumption and all-cause, cancer and CVD mortality: Analysis of Health Survey for England data. J Epidemiol Commun Health. 2014.
Cole DA, Maxwell SE. Testing meditational models with longitudinal data: Questions and tips in the use of structural equation modelling. J Abnorm Psych. 2003; 112: 558-577. CrossRef
Asparouhov T, Masyn K, Muthén B. Continuous time survival in latent variable models. In Proceedings of the Joint Statistical Meeting, American Statistical Association, Biometrics Section, Seattle, Washington, 2006: 180–187.
- A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study
PhD K. M. Appleton
PhD J. V. Woodside
MD D. Arveiler
MD B. Haas
PhD P. Amouyel
MD M. Montaye
MD J. Ferrieres
MD J. B. Ruidavets
MD J. W. G. Yarnell
MD F. Kee
MD A. Evans
MA A. Bingham
PhD P. Ducimetiere
PhD C. C. Patterson
for the PRIME study group
- Springer US