Common mental disorder and physical illness in the Renfrew and Paisley (MIDSPAN) study Farhat Rasul a , Stephen A. Stansfeld a, *, C.L. Hart b , Charles Gillis b , George Davey Smith c a Department of Psychiatry, St. Bartholomew’s and Royal London School of Medicine and Dentistry, Queen Mary, University of London, Mile End Road, London E1 4NS, UK b Department of Public Health, University of Glasgow, Glasgow, UK c Department of Social Medicine, University of Bristol, Bristol, UK Received 3 July 2001; accepted 29 November 2001 Abstract Objective and Methods: The relationship between psycho- logical distress measured by the General Health Questionnaire 30 (GHQ-30) and risk factors for coronary heart disease, angina, electrocardiogram (ECG) abnormalities and chronic sputum was modelled using logistic regression on baseline data from a community study of 15,406 men and women. Results: Psycho- logical distress was associated with low forced expiratory volume (FEV 1 ) and low body mass index (BMI) in men, and low systolic blood pressure only in women. There were associations between psychological distress and coronary heart disease and cardiores- piratory outcomes. The associations were particularly strong for angina without ECG abnormalities (Men: OR 3.26, 95% CI 2.52– 4.21; Women: OR 2.89, 95% CI 2.35– 3.55) and for angina with ECG abnormalities (Men: OR 2.68, 95% CI 2.03 – 4.52; Women: OR 2.88, 95% CI 1.89– 4.39), in both men and women, even after adjusting for classical CHD and cardiorespiratory risk factors. An association between psychological distress and severe chest pain, indicative of previous myocardial infarction, was found in both men and women (Men: OR 1.89, 95% CI 1.44– 2.47; Women: OR 1.91, 95% CI 1.48–2.47), respectively, and between psychological distress and ECG ischaemia, but in men only (OR 1.32, 95% CI 1.00 – 1.76). Conclusion: The association between psychological distress and cardiorespiratory outcomes is likely to be a consequence of the pain and discomfort of the symptoms of the illness. Chest pain may also be a symptom of psychological distress. However, psychological distress, as a predictor and possible risk factor increasing the risk of coronary heart disease, cannot be ruled out. D 2002 Elsevier Science Inc. All rights reserved. Keywords: Psychological distress; General Health Questionnaire; Coronary heart disease; Cross-sectional analyses Introduction The comorbidity of psychiatric disorders with chronic health conditions is a topic of considerable clinical and policy interest. It is important that both clinicians and policy makers recognise the implications for health-related quality of life that result from comorbidity of psychiatric disorders with chronic medical illnesses. Physical illness There are several potential mechanisms for the asso- ciation of physical and psychiatric disorders. Psychiatric disturbance may be either a consequence of the experience of physical symptoms or an example of reporting bias, or the result of common risk factors for both physical and psychiatric disorders or it may be an aetiological agent in physical illness. Using specific measures of depression, community stud- ies have consistently found associations among psychiatric disorder and coronary heart disease [1–3], chest pain [4–6] and angina pectoris [7–9]. Depression may lead to a poorer CHD risk factor profile, e.g., increased smoking, decreased physical activity, higher 0022-3999/02/$ – see front matter D 2002 Elsevier Science Inc. All rights reserved. PII:S0022-3999(02)00352-5 * Corresponding author. Tel.: +44-207-882-7727; fax: +44-207-882- 7924. E-mail address: s.stansfeld@mds.qmw.ac.uk (S.A. Stansfeld). Journal of Psychosomatic Research 53 (2002) 1163– 1170