Controlled direct effect of psychiatric disorders on cardiovascular disease: evidence from a large Kurdish cohort
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RESEARCH ARTICLE
Controlled direct effect of psychiatric disorders on cardiovascular disease: evidence from a large Kurdish cohort Zahra Darabi1, Farid Najafi2, Roya Safari‑Faramani3 and Yahya Salimi4*
Abstract Background: Psychiatric disorders are significantly associated with the incidence and prevalence of cardiovascular diseases, mortality, hospital readmissionn. Oral and dental hygiene may play a role in such association. This study aimed to evaluate the controlled direct effect of psychiatric disorders on cardiovascular diseases by controlling the mediating effect of oral and dental hygiene. Methods: The data used for this study came from the baseline phase of Ravansar Non-communicable Disease (RaNCD) cohort study. RaNCD cohort study is including a representative sample of 10,065 adults (35–65 years old) living in Ravansar, a city in the west of Iran. The marginal structural model with stabilized inverse probability weights accounted for potential confounders was used to estimate the controlled direct effect of psychiatric disorders on car‑ diovascular diseases. Three different models using three mediators including oral and dental hygiene behaviors, oral ulcer and lesions, and decayed, missing, and filled tooth, were used. Results: Psychiatric disorders increase the odds of cardiovascular diseases by 83% (OR = 1.83, CI 1.27, 2.61) and about two times (OR = 2.14, 95% CI 1.74, 2.63) when controlled for oral and dental hygiene behaviors, and oral ulcer and lesions as mediators, respectively. When decayed, missing, and filled tooth, as a mediator, was set at ≤ 8, there was no statistically significant controlled direct effect of psychiatric disorders on cardiovascular diseases (OR = 0.90, 95% CI 0.62, 1.30). Conclusion: Our results suggested that psychiatric disorder was directly related to cardiovascular diseases even if it was possible to have good oral and dental hygiene. The results suggested that interventions targeting people with psychiatric disorders could reduce prevalence of the cardiovascular diseases. Keywords: Cardiovascular disease, Psychiatric disorders, Oral and dental hygiene, Controlled direct effect Background Cardiovascular disease (CVD) is the leading cause of death and morbidity worldwide and accounting globally for around 30% of all deaths [1]. Many effective interventions for primary and secondary prevention of heart *Correspondence: [email protected] 4 Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, 6719851351 Kermanshah, Iran Full list of author information is available at the end of the article
disease rely on identifying people at risk. Despite the reliability of risk prediction models, a significant proportion of CVD cases occur in individuals without known risk factors [2]. Studies have shown that negative emotions, along with psychiatric disorders such as depression, can increase the CVD incidence and mortality [3–5]. Indeed, in people with depression, it is twice as likely to develop myo
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