THE EFFECTS OF STRESS, ANXIETY, AND DEPRESSION ON THE DEVELOPMENT OF CARDIOVASCULAR DISEASE AND INFLAMMATORY DISORDERS IN THE U.S. DEPARTMENT OF ENERGY WORK FORCE Public

Abstract

THE EFFECTS OF STRESS, ANXIETY, AND DEPRESSION
ON THE DEVELOPMENT OF CARDIOVASCULAR DISEASE
AND INFLAMMATORY DISORDERS IN THE
U.S. DEPARTMENT OF ENERGY WORK FORCE


BY
Kellye D. Sliger

For decades, research has shown an association between having a cardiovascular event (CVD)
and the development of stress, anxiety, or depression (SAD). These studies indicate a strong
association between individuals reporting a CVD event and later reporting SAD. As well, many
years of research have shown a strong association between inflammatory disorders (INF) and
SAD. As expected, individuals with active inflammatory disease are more likely to experience
SAD. This analysis examines the temporal relationship between reporting SAD prior to a CVD
event or an INF. Logistic regresion models were conducted with variables considered to be non-
modifiable risk factors.

The data analyzed for this study support the temporal association between SAD and CVD events
or INF. A fully adjusted model, controlling for demographic variables, for the SAD-CVD
association indicated a positive association between reporting a prior SAD diagnosis and
reporting a subsequent CVD diagnosis, OR: 1.68; CI: 1.45, 1.94; P<.0001. For the SAD-INF
association, a fully adjusted model indicated a positive association between reporting a prior
anxiety and a subsequent INF diagnosis, OR: 2.87; CI: 2.19, 3.78; P<.0001.

THE EFFECTS OF STRESS, ANXIETY, AND DEPRESSION
ON THE DEVELOPMENT OF CARDIOVASCULAR DISEASE
AND INFLAMMATORY DISORDERS IN THE
U.S. DEPARTMENT OF ENERGY WORK FORCE

BY

Kellye D. Sliger
M.P.H., Emory University, 2011
B.S., University of Tennessee, 2008


Thesis Committee Chair: Bradley Pearce, Ph.D.



A Thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfillment of the requirements of the degree of
Master of Public Health in the Career MPH Program
2011

Table of Contents

INTRODUCTION......................................................................................................................... 1

MATERIALS AND METHODS................................................................................................. 3

Study Population............................................................................................................................ 3

Table 1. DOE sites included in analysis.......................................................................................... 4

Statistical Methods......................................................................................................................... 7

RESULTS...................................................................................................................................... 7

Table 2. Characteristics of U.S. Department of Energy, Illness and Injury Surveillance Program workers who reported a SAD, CVD, or INF event and those who did not, 1996-2010...................................... 9

Table 3. Distribution of diagnoses among U.S. Department of Energy, Illness and Injury Surveillance Program workers, 1996-2010....................................................................................................................... 10

SAD-CVD Association................................................................................................................ 11

Figure 1. Flow chart of the population used in the SAD-CVD analysis....................................... 11

Table 4. Characteristics of U.S. Department of Energy, Illness and Injury Surveillance Program workers who reported SAD and CVD, 1996-2010............................................................................................ 13

Table 5. Association of stress, anxiety, and depression (SAD) diagnosis with cardiovascular disease (CVD) diagnosis, unadjusted and adjusted for other characteristics of U.S. Department

of Energy, Illness and Injury Surveillance Program workers, 1996-2010..................................... 15

Table 6. Fully Adjusted and Final Logistic Regression Models for the Temporal SAD to

CVD Association Using Data from the U.S. Department of Energy, Illness and Injury

Surveillance Program workers, 1996-2010.................................................................................... 17

SAD-INF Association.................................................................................................................. 18

Figure 2. Flow chart of the population used in the SAD-INF analysis......................................... 18

Table 7. Characteristics of U.S. Department of Energy, Illness and Injury Surveillance Program

workers who reported SAD and INF 1996-2010.......................................................................... 19

Table 8. Association of stress, anxiety, and depression (SAD) diagnosis with inflammatory disorders (INF), unadjusted and adjusted for other characteristics of U.S. Department of Energy, Illness and Injury Surveillance Program workers, 1996-2010......................................................................................................... 21

Table 9. Fully Adjusted and Final Logistic Regression Models for the Temporal SAD to INF Association Using Data from the U.S. Department of Energy, Illness and Injury Surveillance

Program workers, 1996-2010......................................................................................................... 23

DISCUSSION.............................................................................................................................. 23

Methodological Considerations................................................................................................... 24

REFERENCES........................................................................................................................... 27

APPENDIX A. ABBREVIATIONS.......................................................................................... 30

APPENDIX B. ICD-9-CM CODES USED IN ANALYSIS................................................... 31

APPENDIX C. VARIABLE GROUPS.................................................................................... 34

APPENDIX D. IRB DOCUMENTATION.............................................................................. 36

APPENDIX D. SAS OUTPUT.................................................................................................. 48

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Occupational Health and Safety Health Sciences, Epidemiology
Mot-clé	stress depression cardiovascular inflammatory anxiety
Committee Chair / Thesis Advisor	Pearce, Brad, Emory University
Committee Members	Ellis, Elizabeth, Oak Ridge Institute for Science and Education
Partnering Agencies	US (Federal) agency other than CDC

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