Mental Health & Heart Risk

What types of mental health problems can contribute to heart disease?

The mental health problems that can play a role in heart disease are usually broken down into 2 categories: emotional factors, including depression, anxiety, and hostility; and chronic stressors, including low social support, the strain of being a caregiver, and work stress.

How common are mental health problems for people with heart disease?

A large survey showed that 2.8% of otherwise healthy people experienced psychological distress—symptoms that fall short of a diagnosis for mental illness. By comparison, 10% of women with heart failure, 6.4% for those who had had a heart attack, and 4.1% of people with other types of heart disease experienced psychological distress. In this survey, women were more likely than men to show signs of psychological distress (67.2% vs. 32.8%).

Women are also more prone to depression than men after a heart attack or bypass surgery. A study of more than 93,000 women found that having any sort of serious heart-related event. such as a heart attack or stroke or a major procedure to treat heart disease (e.g., bypass surgery) makes a person much more likely to suffer from depression. Your doctor can recommend ways to deal with any mental health problems you may be having.

What is depression?

A person is considered to be clinically depressed if they have a depressed mood and a lack of interest in activities that used to be enjoyable, lasting for at least 2 weeks, and accompanied by at least one of the following: changes in appetite, sleep disturbance, fatigue, agitation, feelings of guilt or worthlessness, problems concentrating, and suicidal thoughts.

Symptoms of Depression – National Institute of Mental Health

  • Persistent sad, anxious, or empty mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, waking up early, or oversleeping
  • Loss of appetite and weight loss, or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

How common is depression?

According to the National Institute for Mental Health, about 18.8 million Americans (9.5% of the population) 18 years and older suffer from depression in a given year; nearly twice as many women (12%) as men (6.6%) suffer from depression each year.

An even greater number of women have depressive symptoms that are not severe enough to be classified as clinical depression. In the Women’s Health Initiative Study (WHI) of more than 93,000 postmenopausal women without clinical depression, depressive symptoms were reported by nearly 16% of women. Hispanic and American-Indian Alaskan-Native women had the highest rates of depressive symptoms while Asian-Pacific Islanders had the lowest rates.

How common is depression for people with heart disease?

A national survey found that for people age 15 to 54 years, about 5% will suffer from depression. The rate of depression among people with heart disease was about 3 times higher (15%).

How does depression affect my risk of heart disease?

Depression affects heart health in many ways, though more research is needed to understand exactly how. Depression can alter your heart’s ability to beat properly; it can increase the buildup of fatty plaques in your blood vessels; and it has been linked to eating and exercise habits.

A study of nearly 63,000 women in the Nurse’s Health Study found that women who experienced the symptoms of depression were 50% more likely to die of heart disease than women who did not, even after other heart disease risk factors were taken into account. Depression also increases the chance of having another heart attack in people who have already had one. The more depressed you are, the higher your risk of having heart troubles.

Anxiety :

What is anxiety?

Anxiety is a state of fear, worry, or uneasiness, sometimes about future events. Anxiety may also occur in certain situations, as is the case with social anxiety. It may also take the form of panic attacks. Phobic anxiety is a condition where a specific phobia causes a person to have anxiety. A phobia is a fear that is irrational or excessive.

Accompanying the fear is a strong desire to avoid what you fear and, in some cases, an inability to function at normal tasks in your job or social settings. Examples of phobias include fear of enclosed spaces, fear of heights, or fear of being out in public.

How common is anxiety for people with heart disease?

Approximately 19.1 million Americans age 18 to 54 have an anxiety disorder (13.3% of the total population). Women are more likely than men to have an anxiety disorder, and about twice as many women than men suffer from panic disorder, post traumatic stress disorder, generalized anxiety, agoraphobia (fear of open spaces), as well as other phobias.

Symptoms of Anxiety – National Institute of Mental Health

  • Unable to relax or concentrate
  • Easily startled
  • Fatigue
  • Headaches
  • Muscle tension and muscle aches
  • Trembling or twitching
  • Irritability
  • Sweating or hot flashes
  • Feeling lightheaded or out of breath
  • Nauseous
  • Going to the bathroom frequently
  • Trouble falling or staying asleep

How does anxiety affect my risk of heart disease?

General anxiety has been linked to heart disease risk in only a few studies. However, having a phobia has been strongly linked to poor heart health in men but not in women. Three studies of nearly 35,000 men have shown a strong link between phobic anxiety and death from heart disease. However, one large study of more than 72,000 women did not conclusively find a link between this kind of anxiety and heart disease-related deaths. Women are more likely than men to suffer anxiety from their phobias, and this condition is often linked to depression.

Anxiety affects the way the heart beats, making it less able to adjust to increases in heart rate. Anxiety has been linked to an increased risk of sudden cardiac death—a sudden, unexplained failure of the heart, often with little or no warning—but not the risk of heart attacks.

Type A Personality :

What is a type A personality?

A type A personality is someone who is ambitious, has a strong sense of time urgency, is hostile, speaks quickly, and is easily angered or aroused.

Can a type A personality affect my risk of heart disease?

While some earlier studies suggested that type A personality doubled your risk of heart disease and made you 5 times more likely to have a recurrent heart attack, other studies have found no association between type A personality and heart disease risk. It is now thought that the component of type A behavior that is in some way bad for your heart is hostility.

What is hostility?

A hostile person commonly feels negatively towards personal relationships and is often angry, cynical, and mistrusting. Hostile people reportedly smoke more and consume more alcohol and animal fat. They are also more likely to have high cholesterol than mild-mannered people.

How can hostility affect my risk of heart disease?

Some, but not all, studies in healthy people have shown a link between hostility and higher risks of heart disease and dying young. Two studies involving more than 1,300 women found that hostile women were twice as likely to have a heart attack and had more fatty plaque clogging up their arteries than their more pleasant peers. Another study found that hostile women, both with and without a family history of heart disease, had a greater risk of developing the metabolic syndrome, a group of heart disease risk factors including high blood sugar and a large waistline. Other studies conducted in Japan, Finland, and the United States have also linked hostility to heart disease.

Some studies, however, question this connection. A study of more than 20,000 people in England did not find a connection between hostility and heart disease in either men or women. A study of 206 heart disease patients in Nova Scotia (78 were women) found no connection between hostility and heart attacks in women. However, hostile women were much more likely to report having diabetes, and this study did see a significant association between hostility and heart attack in men.

Stress and Heart Risk :

What is stress?

Stress is a mentally or emotionally disruptive condition that occurs in response to outside influences. It is usually characterized by a faster heart rate, a rise in blood pressure, tensing of the muscles, irritability, and depression.

Can stress affect my risk of heart disease?

Yes. However, when researchers talk about the effects of stress, they speak specifically to the kinds of events that trigger this response. Many of these triggers are short term, such as experiencing a death in the family or surviving a car crash. However, stressors that are likely to affect your risk of heart disease are more long term. They are often called chronic stressors. Chronic stressors include those discussed below.

Lack of social support

Social support is the friendship, encouragement, and companionship that family and friends provide. People with fewer connections to friends and family have a higher risk of heart disease and heart attack. In a review of 15 studies that examined the effects of social factors on heart disease, having a relatively small network of family and friends increased a person’s risk of having heart disease 2 to 3 fold over time, compared with people who have larger social support groups.

In a study of over 500 women who likely had heart disease, those who had larger, more supportive social networks had fewer risk factors including lower blood sugar levels, lower rates of smoking, and lower rates of high blood pressure and diabetes, and were slimmer than those with smaller social circles.

While living alone has been shown to increase the risk of heart disease in men, the same has not been seen in women because women are more likely than men to develop close friendships outside of marriage.


Not earning much money increases the risk of heart attacks in both healthy people and those with heart disease. This may be due, in part, to both the stress of poverty and reduced access to healthcare. Poverty has also been linked to poorer health habits, higher rates of heart disease risk factors, increased levels of high-risk behaviors such as smoking and drinking alcohol, and other psychosocial risk factors such as chronic stress. Researchers also think that much of the risk associated with smaller social circles could be explained by income level. A large, all-female study showed that women with the fewest social ties were much more likely to have an annual income below $20,000 and a low income level was significantly associated with an increased risk of death. Your income level is also related to the type of work you do, which may influence your stress level.

Work-related stress

The relationship between work stress and heart disease is still up for discussion. Data from a study of more than 3,000 people (44% were women) show that over 10 years, women in high-powered jobs with high degrees of authority and control had almost 3 times the risk of developing heart disease than women in high-demand jobs who had little control over the work they do, such as factory workers. This is different than the findings in men, where those with lots of control over their work are less likely to have heart disease than those with busy jobs but little control . In another large study of over 10,000 people, being stressed at work was significantly related to heart disease risk in men and women, regardless of job type.

In a study of more than 1,300 women, having a “high pressure deadline at work” made both men and woman 6 times more likely to have a heart attack within the next 24 hours. A change in financial circumstances tripled a woman’s risk of heart attack. Women were also 3 times more likely to experience a heart attack if they had recently taken on more responsibilities at work, particularly if they were unhappy about these new responsibilities.

However, the Nurses’ Health Study of more than 35,000 women found that job strain was not related to an increased risk of heart disease. Women in this study were between the ages of 46 and 71 and were followed for an average of 4 years. Though they were all registered nurses, they performed different jobs, some of which were more stressful than others. After adjusting for other risk factors including age and smoking, women in high-strain jobs did not have a higher incidence of heart disease compared with those in low-strain jobs, and neither women in active or passive jobs showed an increased risk of heart disease.

Marital stress

Marital stress may be a greater risk for women who already have some form of heart disease than for those with healthy hearts. One all-female report found that severe stress in a marriage or live-in relationship can triple a woman’s risk of a second heart attack or angina. Marital stress may also affect risk factors. Women in the Pittsburgh Healthy Women Study who were either dissatisfied with their marriage, were divorced, or widowed were significantly more likely to develop metabolic syndrome after nearly 12 years. Single women, however, showed no significant difference from happily married women.

Caregiver stress

Caring for people who are elderly, ill, or disabled is burdensome and stressful for many families and may lead to depression. Studies have shown that female caregivers are less likely to take care of their own health, and their blood pressure tends to rise when they are in the presence of the person they care for.

In the Nurses Health Study, of more than 54,000 women, those who cared for a disabled or ill spouse for 9 hours or more per week were about twice as likely to develop heart disease in the next 4 years. However, caring for disabled or ill parents, children, or friends did not significantly increase a woman’s risk. Other results from the Nurse’s Health Study also showed that being under strain from care giving could increase your risk of death from any cause.

Caring for a family member or spouse isn’t always bad for your health. The risks are not due to the act of care giving alone, but occur only when the act is viewed as stressful.

How can depression or stress be treated?

There are many things you can do to combat depression and stress. Finding social support either from friends and family or through a support group can be helpful. Managing your stress can also help treat depression.

There are also several different types of treatments available for women who are under a lot of stress—the key is to find the method that is right for you. Many women find that relaxation exercises and meditation help alleviate stress. Relaxation exercises involve the flexing and releasing of major muscle groups. Breathing exercises also help to reduce stress. Exercise has also been shown to be a very effective way of reducing stress because it reduces the amount of stress hormones that your body releases. Many cardiac rehabilitation programs also teach stress management techniques.

If you can’t lower stress or depression by yourself, you may want professional help. Licensed therapists, psychologists, marriage and family therapists, pastoral counselors, clinical social workers, and psychiatrists offer short-term psychotherapy. A psychiatrist may also help a person overcome their depression. Talk to your doctor. There are medications that he or she can prescribe to help treat depression called selective serotonin re-uptake inhibitors such as Zoloft and Paxil. Though these medications do have serious side effects, most studies show that they are safe and effective for people with heart disease. Your doctor can help you weigh the risks and benefits of using these medications.

For more information: – The National Institute of Mental Health – The American Psychological Association – The Depression and Bipolar Support Alliance

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