Psych distress screening can flag heart disease risk

Clinicians can provide a brief mental health questionnaire to a patient during a visit and, based on the self-reported answers, get a better idea of not only that patient’s mental health risks, but also their associated risk for cardiovascular disease, says Carly Goldstein. (Credit: Getty Images)

Screening for psychological distress can be an effective way to assess a patient’s risk for cardiovascular disease, a new study shows.

What’s more, the screening process can be easy—even for health care providers without significant psychology training—and efficient, the researchers say.

In a meta-analysis that included more than 600,000 patients across 28 studies, the researchers determined that psychological distress assessed with brief questionnaires was associated with nearly a 30% greater risk of cardiovascular disease.

The results indicate that clinicians can provide a brief mental health questionnaire to a patient during a visit and, based on the self-reported answers, get a better idea of not only that patient’s mental health risks, but also their associated risk for cardiovascular disease, says Carly Goldstein, an assistant professor of psychiatry and human behavior (research) at Brown University’s Warren Alpert Medical School and coauthor of the study in the Journal of Cardiopulmonary Rehabilitation and Prevention.

The clinician can then choose to make recommendations to the patient around improving their mental health to help them improve their cardiovascular health, Goldstein says.

“This analysis shows that a patient’s psychological distress is directly associated with their cardiovascular risk, providing opportunities for clinicians to help a patient manage their risks over time, for better overall health, right at the point of care,” Goldstein says.

Cardiovascular disease prevention

Ample evidence shows that psychological distress—including elevated symptoms of depression, anxiety, post-traumatic stress disorder, and psychosocial stress—is associated with cardiovascular disease risk. However, there wasn’t a practical application of this information for clinicians, Goldstein says.

Moreover, she adds, it was unknown whether a brief screener 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, says coauthor Allison Gaffey, a clinical psychologist with the internal medicine department at Yale School of Medicine who completed her predoctoral internship at Brown’s medical school.

“Certainly we know that psychological health is important within the scope of managing care,” Gaffey says. 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, she says.

To look for associations among the general public, the researchers searched three large databases for studies including adults without a past psychiatric diagnosis, who were screened for depression, anxiety, PTSD, stress, or general mental health symptoms, and followed for more than six months to determine their risk for cardiovascular diseases. 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 screeners was indeed associated with cardiovascular disease: The researchers found that participants reporting high psychological distress showed a 28% greater risk of cardiovascular disease compared to those with low or no distress.

The screeners in the analyzed studies were brief and well-known and could therefore be administered with confidence by any clinical provider, Gaffey says.

“We believe that using these brief screeners, whether in a hospital or a community health care setting, provides feedback that is helpful in understanding risk for cardiovascular disease in a very multidimensional way compared to only using more standard assessments like blood pressure or cholesterol levels,” she says.

“Even without meeting criteria necessarily for, say, high psychological distress, those patients who are exhibiting any psychological distress may still benefit from additional clinical support in order to aid their prevention of cardiovascular disease.”

Mental health screening

The findings follow updated guidelines from the American Heart Association that expand the checklist of health and lifestyle factors for optimal cardiovascular health. The researchers note that while “healthy sleep” was added as an essential aspect of good heart health, “managing stress and mental health” was not.

“There is a solid amount of evidence indicating that individuals who have high psychological distress tend to do worse with the other factors on the checklist,” says coauthor Emily Gathright, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School. “Our study is part of the accumulating evidence that psychological distress is a really important factor in a cardiovascular diagnosis, such as the other health behaviors and risk factors, like physical activity and cholesterol levels, that clinicians monitor.”

In other words, the checklist should be expanded to include good mental health, the researchers say.

Goldstein notes that in the studies the researchers looked at in their analysis, by far the most common domain of psychological distress that was assessed was depression. Because anxiety also contributes to psychological distress and may even manifest in ways distinct from depression, she suggests that screeners used in clinical practice include ways to fully evaluate for anxiety as well as depression.

The three psychology researchers work in cardiac rehabilitation, Goldstein says, and are therefore familiar with how supporting psychological health supports cardiovascular health.

“I would encourage all providers, cardiovascular, and specialty providers as well as primary care providers, to do some kind of brief screening for psychological distress to assess cardiovascular risk,” Goldstein says.

“And I would argue that every provider’s office can make brief recommendations to patients who warrant them, which may be as simple as pointing towards free, publicly available mental health resources.”

Just as the screening process can be brief and efficient, Goldstein adds, so can the mental health support recommendations, and both stand to make a difference in the patient’s overall health.

Source: Brown University