This prospective population-based study investigated whether having any internalizing mental disorder (INT) was associated with the presence and onset of any cardiometabolic disorder (CM) at 3-year follow-up; and vice versa. Furthermore, we examined whether observed associations differed when using longer time intervals of respectively 6 and 9 years.
Data were used from the four waves (baseline and 3-, 6- and 9-year follow-up) of the Netherlands Mental Health Survey and Incidence Study-2, a prospective study of a representative cohort of adults. At each wave, the presence and first onset of INT (i.e. any mood or anxiety disorder) were assessed with the Composite International Diagnostic Interview 3.0; the presence and onset of CM (i.e. hypertension, diabetes, heart disease, and stroke) were based on self-report. Multilevel logistic autoregressive models were controlled for previous-wave INT and CM, respectively, and sociodemographic, clinical, and lifestyle covariates.
Having any INT predicted both the presence (OR 1.28, p = 0.029) and the onset (OR 1.46, p = 0.003) of any CM at the next wave (3-year intervals). Having any CM was not significantly related to the presence of any INT at 3-year follow-up, while its association with the first onset of any INT reached borderline significance (OR 1.64, p = 0.06), but only when examining 6-year intervals.
Our findings indicate that INTs increase the risk of both the presence and the onset of CMs in the short term, while CMs may increase the likelihood of the first onset of INTs in the longer term. Further research is needed to better understand the mechanisms underlying the observed associations.
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Vos T, Allen C, Arora M et al (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1545–1602. https://doi.org/10.1016/S0140-6736(16)31678-6
Baxter AJ, Vos T, Scott KM et al (2014) The global burden of anxiety disorders in 2010. Psychol Med 44:2363–2374. https://doi.org/10.1017/S0033291713003243
Kyu HH, Abate D, Abate KH et al (2018) Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1859–1922. https://doi.org/10.1016/S0140-6736(18)32335-3
Forouzanfar MH, Afshin A, Alexander LT et al (2016) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1659–1724. https://doi.org/10.1016/S0140-6736(16)31679-8
Thombs BD, Bass EB, Ford DE et al (2005) Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med 21:30–38. https://doi.org/10.1111/j.1525-1497.2005.00269x.J
Smith KJ, Béland M, Clyde M et al (2013) Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res 74:89–99. https://doi.org/10.1016/j.jpsychores.2012.11.013
Hackett ML, Pickles K (2014) Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke 9:1017–1025. https://doi.org/10.1111/ijs.12357
Tully PJ, Cosh SM, Baumeister H (2014) The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. J Psychosom Res 77:439–448. https://doi.org/10.1016/j.jpsychores.2014.10.001
Pan Y, Cai W, Cheng Q et al (2015) Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies. Neuropsychiatr Dis Treat 11:1121–1130. https://doi.org/10.2147/NDT.S77710
Feng L, Li L, Liu W et al (2019) Prevalence of depression in myocardial infarction: a PRISMA-compliant meta-analysis. Medicine (Baltimore) 98:e14596. https://doi.org/10.1097/MD.0000000000014596
Khaledi M, Haghighatdoost F, Feizi A, Aminorroaya A (2019) The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol 56:631–650. https://doi.org/10.1007/s00592-019-01295-9
Li M, Zhang XW, Hou WS, Tang ZY (2015) Impact of depression on incident stroke: a meta-analysis. Int J Cardiol 180:103–110. https://doi.org/10.1016/j.ijcard.2014.11.198
Smith KJ, Deschênes SS, Schmitz N (2018) Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta-analysis. Diabet Med 35:677–693. https://doi.org/10.1111/dme.13606
Batelaan NM, Seldenrijk A, Bot M et al (2016) Anxiety and new onset of cardiovascular disease: critical review and meta-analysis. Br J Psychiatry 208:223–231. https://doi.org/10.1192/bjp.bp.114.156554
Pan A, Sun Q, Okereke OI et al (2011) Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA 306:1241–1249. https://doi.org/10.1001/jama.2011.1282
Dong JY, Zhang YH, Tong J, Qin LQ (2012) Depression and risk of stroke: a meta-analysis of prospective studies. Stroke 43:32–37. https://doi.org/10.1161/STROKEAHA.111.630871
Meng L, Chen D, Yang Y et al (2012) Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. J Hypertens 30:842–851. https://doi.org/10.1097/HJH.0b013e32835080b7
Rotella F, Mannucci E (2013) Depression as a risk factor for diabetes: a meta-analysis of longitudinal studies. J Clin Psychiatry 74:31–37. https://doi.org/10.4088/JCP.12r07922
Hasan SS, Clavarino AM, Mamun AA, Kairuz T (2014) Incidence and risk of diabetes mellitus associated with depressive symptoms in adults: evidence from longitudinal studies. Diabetes Metab Syndr Clin Res Rev 8:82–87. https://doi.org/10.1016/j.dsx.2014.04.023
Nicholson A, Kuper H, Hemingway H (2006) Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146,538 participants in 54 observational studies. Eur Heart J 27:2763–2774. https://doi.org/10.1093/eurheartj/ehl338
Van der Kooy K, van Hout H, Marwijk H et al (2007) Depression and the risk for cardiovascular diseases: systematic review and meta analysis. Int J Geriatr Psychiatry 22:613–626. https://doi.org/10.1002/gps.1723
Gan Y, Gong Y, Tong X et al (2014) Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC Psychiatry 14:1–11. https://doi.org/10.1186/s12888-014-0371-z
Rotella F, Mannucci E (2013) Diabetes mellitus as a risk factor for depression. A meta-analysis of longitudinal studies. Diabetes Res Clin Pract 99:98–104. https://doi.org/10.1016/j.diabres.2012.11.022
Hasan SS, Mamun AA, Clavarino AM, Kairuz T (2014) Incidence and risk of depression associated with diabetes in adults: evidence from longitudinal studies. Community Ment Health J 51:204–210. https://doi.org/10.1007/s10597-014-9744-5
Long J, Duan G, Tian W et al (2015) Hypertension and risk of depression in the elderly: a meta-analysis of prospective cohort studies. J Hum Hypertens 29:478–482. https://doi.org/10.1038/jhh.2014.112
Zhang D, Tang X, Shen P et al (2019) Multimorbidity of cardiometabolic diseases: prevalence and risk for mortality from one million Chinese adults in a longitudinal cohort study. BMJ Open 9:e024476. https://doi.org/10.1136/bmjopen-2018-024476
Sakakibara BM, Obembe AO, Eng JJ (2019) The prevalence of cardiometabolic multimorbidity and its association with physical activity, diet, and stress in Canada: evidence from a population-based cross-sectional study. BMC Public Health 19:1–9. https://doi.org/10.1186/s12889-019-7682-4
De Graaf R, Ten Have M, Van Gool C, Van Dorsselaer S (2012) Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Soc Psychiatry Psychiatr Epidemiol 47:203–213. https://doi.org/10.1007/s00127-010-0334-8
Kessler RC, Chiu WT, Demler O et al (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627. https://doi.org/10.1001/archpsyc.62.6.617
Nesto RW (2004) Correlation between cardiovascular disease and diabetes mellitus: current concepts. Am J Med 116(Suppl):11S-22S. https://doi.org/10.1016/j.amjmed.2003.10.016
Martín-Timón I (2014) Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J Diabetes 5:444-470. https://doi.org/10.4239/wjd.v5.i4.444
Carragher N, Krueger RF, Eaton NR, Slade T (2015) Disorders without borders: current and future directions in the meta-structure of mental disorders. Soc Psychiatry Psychiatr Epidemiol 50:339–350. https://doi.org/10.1007/s00127-014-1004-z
Forbes MK, Tackett JL, Markon KE et al (2017) Approach to understanding psychopathology across the lifespan. 28:971–986. https://doi.org/10.1017/S0954579416000651
Chen PC, Chan YT, Chen HF et al (2013) Population-based cohort analyses of the bidirectional relationship between type 2 diabetes and depression. Diabetes Care 36:376–382. https://doi.org/10.2337/dc12-0473
de Graaf R, Ten Have M, van Dorsselaer S (2010) The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods. Int J Methods Psychiatr Res 19:125–141. https://doi.org/10.1002/mpr.317
Kessler RC, Ustün TB (2004) The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13:93–121
Haro JM, Arbabzadeh-Bouchez S, Brugha TS et al (2006) Concordance of the composite international diagnostic interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 15:167–180
Penninx BWJH, Beekman ATF, Smit JH et al (2008) The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods. Int J Methods Psychiatr Res 17:121–140. https://doi.org/10.1002/mpr.256
Baker MM, Stabile M, Deri C (2001) What do self-reported, objective measures of health measure? National Bureau of Economic Research, Cambridge
National Center for Health Statistics (1994) Vital and health statistics. Evaluation of national health interview survey diagnostic reporting. Series 2: data evaluation and methods research, no. 120. Hyattsville, Maryland, Department of Health and Human Services
Batelaan NM, ten Have M, van Balkom AJLM et al (2014) Anxiety disorders and onset of cardiovascular disease: the differential impact of panic, phobias and worry. J Anxiety Disord 28:252–258. https://doi.org/10.1016/j.janxdis.2013.12.003
Craig CL, Marshall AL, Sjöström M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB
British Medical Association (1995) Alcohol guidelines on sensible drinking. British Medical Association, London
Haynes JC, Farrell M, Singleton N et al (2005) Alcohol consumption as a risk factor for anxiety and depression: results from the longitudinal follow-up of the National Psychiatric Morbidity Survey. Br J Psychiatry 187:544–551. https://doi.org/10.1192/bjp.187.6.544
Lustman PJ, Anderson RJ, Freedland KE et al (2000) Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 23:934–942. https://doi.org/10.2337/diacare.23.7.934
Anderson RJ, Grigsby AB, Freedland KE et al (2002) Anxiety and poor glycemic control: a meta-analytic review of the literature. Int J Psychiatry Med 32:235–247. https://doi.org/10.2190/KLGD-4H8D-4RYL-TWQ8
Meijer A, Conradi HJ, Bos EH et al (2013) Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. Br J Psychiatry 203:90–102. https://doi.org/10.1192/bjp.bp.112.111195
Roest AM, Martens EJ, Denollet J, de Jonge P (2010) Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis. Psychosom Med 72:563–569. https://doi.org/10.1097/PSY.0b013e3181dbff97
Freedland KE, Carney RM (1992) Major depression in coronary artery disease patients with vs without a prior history of depression major depression. Psychosom Med 421:416–421
Spijkerman T, De Jonge P, Van Den Brink RHS et al (2005) Depression following myocardial infarction: first-ever versus ongoing and recurrent episodes. Gen Hosp Psychiatry 27:411–417. https://doi.org/10.1016/j.genhosppsych.2005.05.007
de Jonge P, van den Brink RHS, Spijkerman TA, Ormel J (2006) Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events. J Am Coll Cardiol 48:2204–2208. https://doi.org/10.1016/j.jacc.2006.06.077
Goodman J, Shimbo D, Haas DC et al (2008) Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients. J Psychiatr Res 42:670–675. https://doi.org/10.1016/j.jpsychires.2007.07.004
NEMESIS-2 is conducted by The Netherlands Institute of Mental Health and Addiction (Trimbos Institute) in Utrecht. Financial support has been received from the Ministry of Health, Welfare and Sport, with supplementary support from The Netherlands Organization for Health Research and Development (ZonMw) and the Genetic Risk and Outcome of Psychosis (GROUP) investigators.
Conflict of interest
The authors declare that they have no conflicts of interest.
NEMESIS-2 was approved by the Medical Ethics Review Committee for Institutions on Mental Health Care (METIGG). After having been informed about the study aims, respondents provided written informed consent at each wave.
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Nuyen, J., Bos, E.H., de Jonge, P. et al. Longitudinal bidirectional associations between internalizing mental disorders and cardiometabolic disorders in the general adult population. Soc Psychiatry Psychiatr Epidemiol 56, 1611–1621 (2021). https://doi.org/10.1007/s00127-020-02007-3
- Internalizing mental disorders
- Cardiometabolic disorders
- Adult general population
- Prospective cohort study