Fear and distress disorders as predictors of heart disease: A temporal perspective

Roest, A. M., de Jonge, P., Lim, C. W. W., Stein, D. J., Al-Hamzawi, A., Alonso, J., Benjet, C., Bruffaerts, R., Bunting, B., Caldas-de-Almeida, J. M., Ciutan, M., de Girolamo, G., Hu, C., Levinson, D., Nakamura, Y., Navarro-Mateu, F., Piazza, M., Posada-Villa, J., Torres, Y., Wojtyniak, B., Kessler, R. C. and Scott, K. M. (2017) Fear and distress disorders as predictors of heart disease: A temporal perspective. Journal of Psychosomatic Research, 96 67-75. doi:10.1016/j.jpsychores.2017.03.015

Author Roest, A. M.
de Jonge, P.
Lim, C. W. W.
Stein, D. J.
Al-Hamzawi, A.
Alonso, J.
Benjet, C.
Bruffaerts, R.
Bunting, B.
Caldas-de-Almeida, J. M.
Ciutan, M.
de Girolamo, G.
Hu, C.
Levinson, D.
Nakamura, Y.
Navarro-Mateu, F.
Piazza, M.
Posada-Villa, J.
Torres, Y.
Wojtyniak, B.
Kessler, R. C.
Scott, K. M.
Title Fear and distress disorders as predictors of heart disease: A temporal perspective
Journal name Journal of Psychosomatic Research   Check publisher's open access policy
ISSN 1879-1360
Publication date 2017-05-01
Sub-type Article (original research)
DOI 10.1016/j.jpsychores.2017.03.015
Open Access Status Not yet assessed
Volume 96
Start page 67
End page 75
Total pages 9
Place of publication Philadelphia, PA United States
Publisher Elsevier
Formatted abstract

Few studies have been able to contrast associations of anxiety and depression with heart disease. These disorders can be grouped in fear and distress disorders. Aim of this study was to study the association between fear and distress disorders with subsequent heart disease, taking into account the temporal order of disorders.


Twenty household surveys were conducted in 18 countries (n = 53791; person years = 2,212,430). The Composite International Diagnostic Interview assessed lifetime prevalence and age at onset of disorders, and respondents were categorized into categories based on the presence and timing of fear and distress disorders. Heart disease was indicated by self-report of physician-diagnosed heart disease or self-report of heart attack, together with year of onset. Survival analyses estimated associations between disorder categories and heart disease.


Most respondents with fear or distress disorders had either pure distress or pure fear (8.5% and 7.7% of total sample), while fear preceded distress in the large majority of respondents with comorbid fear and distress (3.8% of total sample). Compared to the “no fear or distress disorder” category, respondents with pure fear disorder had the highest odds of subsequent heart disease (OR:1.8; 95%CI:1.5–2.2; p < 0.001) and compared to respondents with pure distress disorder, these respondents were at a significantly increased risk of heart disease (OR:1.3; 95%CI:1.0–1.6; p = 0.020).


This novel analytic approach indicates that the risk of subsequent self-reported heart disease associated with pure fear disorder is significantly larger than the risk associated with distress disorder. These results should be confirmed in prospective studies using objective measures of heart disease.
Keyword Anxiety
Heart disease
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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Created: Wed, 12 Apr 2017, 07:42:26 EST by Christopher O'Keefe on behalf of Learning and Research Services (UQ Library)