Mental ills linked to physical

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A large British study indicates that people with severe mental illness are significantly more likely to die from heart disease and stroke than those without such conditions, and a U.S. study suggests depression is linked to early symptoms of cardiovascular disease.

Both studies were published in the February issue of Archives of General Psychiatry, a journal of the American Medical Association.

"There are a lot of pathways by which mental health can influence physical health," said Jesse C. Stewart, an assistant professor of psychology at Indiana University-Purdue University Indianapolis, lead author of the study that found an association between depression and the risk of thickened arteries over a three-year period.

"We examined a set of negative emotions, including anxiety, hostility, anger and depression" among 324 men and women averaging 61 years, he said, to determine which, if any, of those emotions are associated with a thickening of arteries related to early-stage arteriosclerosis, the hardening of the arteries.

"We found that only depressive symptoms -- especially physical signs, such as fatigue and loss of appetite -- predicted greater thickening of the artery walls over three years," Mr. Stewart said in an interview.

He acknowledged that this finding seems to go against the "conventional thinking that a person who is angry and hostile is at increased risk for a heart attack." He said the new findings suggest that depression may play an earlier role in the disease process.

Mr. Stewart stressed that these results are "preliminary" and should be studied further. But if further research confirms the findings, he said, no one should be too surprised.

"After all, depression is associated with the autonomic nervous system, which plays a role in blood pressure and heart function," Mr. Stewart noted.

The British research compared the death rates of more than 46,000 people with serious mental disorders, including schizophrenia, bipolar disorder and delusional disorder, with those of nearly 300,500 people without mental illness. The researchers selected subjects from a nationally representative database in Britain.

Over a follow-up period of at least six months, researchers found that those ages 18 to 49 having serious mental illnesses were more than three times as likely to die of heart disease and more than 2 times as likely to die of stroke than those without mental disorders.

The increased mortality risk for the mentally disturbed held true for all age groups. Those 50 to 75 with mental illnesses were nearly twice as likely to die of heart disease and stroke than those without mental conditions. People older than 75 with mental problems were 1.05 times as likely to die of heart disease and 11/3 times as likely to die of stroke as those without mental disorders.

The researchers, David P.J. Osborn and colleagues at the Royal Free and University Medical College in London, said the death rates did not change significantly after adjusting for smoking rates and other heart disease risks.

But the use of anti-psychotic drugs did have an effect.

"People with severe mental illness who were not prescribed any anti-psychotics were at increased risk of coronary heart disease and stroke than controls, whereas those prescribed such agents were at even greater risk," the authors wrote. "Those receiving the higher doses were at greatest risk for death from both coronary heart disease and stroke."