Associations of composite mental health assessment scales with cardiovascular diseases and mortality in population aged 55 years and older

Aim. To develop new composite mental health assessment scales integrating indicators of psycho-emotional and cognitive functioning, and to analyze their associations with cardiovascular diseases (CVD) and mortality in population aged 55 and older.

Material and methods. The study was conducted as part of the prospective cohort study «Stress, Aging, and Health in Russia» (SAHR). A total of 1876 individuals (898 men and 978 women) examined between 2007-2009 were included. Using principal component analysis with varimax rotation applied to 11 initial indicators (self-rated health, quality of life, perceived stress, depression, cognitive status, auditory-verbal memory, level of trust, locus of control, general support, coping strategies), five composite scales were formed: Psychological, Self-Rated Health, Cognitive, Social Adaptation, and Trust Level. Epidemiological diagnosis of arterial hypertension, acute cerebrovascular accident (stroke), coronary artery disease (CAD), and myocardial infarction (MI) was established based on questionnaire data and instrumental examination methods. The median follow-up period was 13 years, during which 559 men and 369 women died, including 296 and 196 from CVD, respectively. Associations of the scales with CVD were analyzed using logistic regression, while associations with all-cause and CVD mortality were analyzed using Cox regression, adjusted for risk factors and CVD.

Results. In men, psychological and cognitive impairments, as well as poor self-rated health, were associated with the presence of stroke, MI, and CAD. In women, these indicators were associated only with stroke and MI (self-rated health). Regarding mortality, multivariate analysis showed that cognitive impairment and poor health according to the self-rated health scale significantly increased the risk of all-cause mortality, regardless of gender and after adjustment for socio-demographic and clinical indicators. Similar results were observed for CVD mortality. In women, problems with social adaptation were an additional risk factor for all-cause mortality

Conclusion. The developed composite mental health assessment scales were significantly associated with CVD and mortality in individuals 55 years and older. The Self-Rated Health and Cognitive Functioning scales have high predictive power for mortality risk in both genders, that highlights their importance in clinical practice for assessing overall health and prognosis.

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