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The association between anxiety and C-reactive protein (CRP) levels: Results from the Northern Finland 1966 Birth Cohort Study

Published online by Cambridge University Press:  16 April 2020

T. Liukkonen ,
P. Räsänen ,
J. Jokelainen ,
M. Leinonen ,
M.-R. Järvelin ,
V.B. Meyer-Rochow  and
M. Timonen
T. Liukkonen*
Affiliation:
Savonlinna Central Hospital, Department of Psychiatry, Keskussairaalantie 6, 57120Savonlinna, Finland University of Oulu, Institute of Health Sciences, Box 5000, 90014University of Oulu, Oulu, Finland
P. Räsänen
Affiliation:
University of Oulu, Department of Psychiatry, Box 5000, 90014Oulu, Finland
J. Jokelainen
Affiliation:
University of Oulu, Institute of Health Sciences, Box 5000, 90014University of Oulu, Oulu, Finland Unit of General Practice, Oulu University Hospital, 90029Oys, Finland
M. Leinonen
Affiliation:
Institute for Health and Welfare, Child and Adolescent Health and Wellbeing Unit, Box 310, 90101Oulu, Finland
M.-R. Järvelin
Affiliation:
University of Oulu, Institute of Health Sciences, Box 5000, 90014University of Oulu, Oulu, Finland Department of Epidemiology and Public Health, Imperial College, Faculty of Medicine, Norfolk Place, London, W21 PG, UK Biocenter Oulu, University of Oulu, Box 5000, 90014Oulu, Finland Lifecourse and service Department, National Institute of Health and Welfare, P.O. Box 310, 90101Oulu, Finland
V.B. Meyer-Rochow
Affiliation:
Jacobs University Bremen, School of Engineering & Science, 28725Bremen, Germany Department of Physiology, Box 5000, 90014University of Oulu, Oulu, Finland
M. Timonen
Affiliation:
University of Oulu, Institute of Health Sciences, Box 5000, 90014University of Oulu, Oulu, Finland Oulu Health Centre, Box 8, 90015Oulu, Finland
*
*Corresponding author. Tel.: +358 15 581 7015; fax: +358 15 5817016. E-mail address: [email protected] (T. Liukkonen).
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Abstract

Background

Anxiety frequently accompanies low-grade inflammation-associated conditions like depression, insulin resistance, coronary heart disease and metabolic syndrome. The association between anxiety and low-grade inflammation is, unlike between depression and low-grade inflammation, a very sparsely studied area in general populations. The aim of the present study was to investigate whether anxiety symptoms as well as comorbid anxiety and depressive symptoms are associated with low-grade inflammation at population level.

Methods

The general population-based Northern Finland 1966 Birth Cohort was followed until age 31 (n = 2688 males and 2837 females), when the highly sensitive CRP concentrations were measured. Anxiety and depressive symptoms were defined by Hopkins Symptom Checklist-25 (HSCL-25).

Results

After adjusting for confounders, logistic regression analyses showed that anxiety symptoms alone increased the probability for elevated hs-CRP levels (> 3.0 mg/L) in males over two-fold (2.19 CI 95% 1.08–4.46), while comorbid anxiety and depressive symptoms caused a 1.7-fold (1.76 CI 95% 1.13–2.74) increase in the probability for elevated hs-CRP levels (1.0–3.0 mg/L).

Conclusions

Our results support the hypothesis that anxiety as well as comorbid anxiety and depression can be associated with an increased risk for low-grade inflammation in males at population level.

Keywords

Anxiety disordersUnipolar depressionEpidemiologyNeuroendogrinology
Type
Original article
Information
European Psychiatry , Volume 26 , Issue 6 , September 2011 , pp. 363 - 369
Copyright
Copyright © Elsevier Masson SAS 2011

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References

Adamopoulos, DA, Karamertzanis, M, Thomopoulos, A, Pappa, A, Koukkou, E, Nicopoulou, SCAge at menopause and prevalence of its different types in contemporary Greek Women. Menopause 2002;9(6):443–448.CrossRefGoogle ScholarPubMed
Albert, CM, Chae, CU, Rexrode, KM, Manson, JE, Kawachi, IPhobic anxiety and risk of coronary heart disease and sudden cardiac death among women. Circulation 2005;111(4):480–487.CrossRefGoogle ScholarPubMed
Aziz, N, Fahey, JL, Detels, R, Butch, AWAnalytic performance of a highly sensitive C-reactive protein-based immunoassay and the effects of laboratory variables on levels of protein in blood. Clin Diagn Lab Immunol 2003;4:652–657.CrossRefGoogle Scholar
Baker, DG, Ekhator, NN, Kasckow, JW, Hill, KK, Zoumakis, E, Dashevsky, BA, et al.Plasma and cerebrospinal fluid interleukin-6 concentrations in posttraumatic stress disorder. Neuroimmunomodulation 2001;9(4):209–217.CrossRefGoogle ScholarPubMed
Bankier, B, Barajas, J, Martinez-Rumayor, A, Januzzi, JLAssociation between C-reactive protein and generalized anxiety disorder in stable coronary heart disease patients. Eur Heart J 2008;29(18):2212–2217.CrossRefGoogle ScholarPubMed
Bankier, B, Barajas, J, Martinez-Rumayor, A, Januzzi, JLAssociation between anxiety and C-reactive protein levels in stable coronary heart disease patients. Psychosomatics 2009;50(4):347–353.CrossRefGoogle ScholarPubMed
Barger, SD, Sydeman, SJDoes generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? J Affect Disord 2005;88(1):87–91.CrossRefGoogle ScholarPubMed
Boyle, SH, Michalek, JE, Suarez, ECDoes generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? Psychosom Med 2006;68(6):844–850.CrossRefGoogle Scholar
Brennan, A, Fargnoli, J, Williams, C, Li, T, Willet, W, Kawachi, I, et al.Phobic anxiety is associated with higher serum concentrations of adipokines and cytokines in women with diabetes. Diabetes care 2009;32(5):926–931.CrossRefGoogle ScholarPubMed
Breslau, N, Kilbey, MM, Andreski, PNicotine dependence and major depression. New evidence from a prospective investigation. Arch Gen Psychiatry 1993;50:31–35.CrossRefGoogle ScholarPubMed
Capuron, L, Miller, AHCytokines and psychopathology: lessons from interferon-alpha. Biol Psychiatry 2004;56(11):819–824.CrossRefGoogle ScholarPubMed
Carney, RM, Freedland, KE, Steinmeyer, B, Blumenthal, JA, Berkman, LF, Watkins, LL, et al.Depression and five year survival following acute myocardial infarction: a prospective study. J Affect Disord 2008;109:133–138.CrossRefGoogle ScholarPubMed
Chae, CU, Lee, RT, Rifai, N, Ridker, PMBlood pressure and inflammation in apparently healthy men. Hypertension 2001;38:399–403.CrossRefGoogle ScholarPubMed
Danner, M, Kasl, SV, Abramson, JL, Vaccarino, VAssociation between depression and elevated C-reactive protein. Psychosom Med 2003;65:347–356.CrossRefGoogle ScholarPubMed
Das, UNIs metabolic syndrome X an inflammatory condition? Exp Biol Med 2002;227(11):989–997.CrossRefGoogle ScholarPubMed
Degoratis, LR, Lipman, RS, Covi, CSCL-90: an outpatient's psychiatric rating scale- preliminary report. Psychopharmacol Bull 1973;9:13–27.Google Scholar
Dreon, DM, Slavin, JL, Phinney, SDOral contraceptive use and increased plasma concentration of C-reactive protein. Life Sciences 2003;73:1245–1252.CrossRefGoogle ScholarPubMed
Empana, JP, Sykes, DH, Luc, G, Juhan-Vague, I, Arveiler, D, Ferrieres, J, et al.Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Circulation 2005;111(18):2299–2305.CrossRefGoogle ScholarPubMed
Evans, DL, Charney, DSMood disorders and medical illness: a major public health problem. Biol Psychiatry 2003;54:177–180.CrossRefGoogle ScholarPubMed
Felger, JC, Alagbe, O, Hu, F, Mook, D, Freeman, AA, Sanchez, MM, et al.Effects of interferon-alpha on rhesus monkeys: a nonhuman primate model of cytokine-induced depression. Biol Psychiatry 2007;62:1324–1333.CrossRefGoogle ScholarPubMed
Festa, A, D’Agostino, R Jr., Howard, G, Mykkänen, L, Tracy, RP, Haffner, SMChronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000;102(1):42–47.CrossRefGoogle ScholarPubMed
Ford, DE, Erlinger, TPDepression and C-reactive protein in US adults: data from the third national health and nutrition examination survey. Arch Intern Med 2004;164:1010–1014.CrossRefGoogle ScholarPubMed
Frasure-Smith, N, Lespérance, FReflections on depression as a cardiac risk factor. Psychosom Med 2005;67Suppl. 1:S19–S25.CrossRefGoogle ScholarPubMed
Freeman, MPDepression and hormonal contraception. JAMA 2001;286:671–672.Google ScholarPubMed
Gimeno, D, Kivimäki, M, Brunner, EJ, Elovainio, M, De Vogli, R, Steptoe, A, et al.Associations of C-reactive protein and interleukin-6 with cognitive symptoms of depression: 12-year follow-up of the Whitehall II study. Psychol Med 2009;39(3):413–423.CrossRefGoogle ScholarPubMed
Goodwin, RDAssociation between physical activity and mental disorders among adults in the United States. Prev Med 2003;36:698–703.CrossRefGoogle ScholarPubMed
Herrán, A, Sierra-Biddle, D, García-Unzueta, MT, Puente, J, Vázquez-Barquero, JL, et al.The acute phase response in panic disorder. Int J Neuropsychopharmacol 2005;8(4):529–535.CrossRefGoogle ScholarPubMed
Howren, MB, Lamkin, DM, Suls, JAssociations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med 2009;71(2):171–186.CrossRefGoogle ScholarPubMed
Huffman, JC, Smith, FA, Blais, MA, Januzzi, JL, Fricchione, GLAnxiety, independent of depressive symptoms, is associated with in-hospital cardiac complications after acute myocardial infarction. J Psychosom Res 2008;65(6):557–563.CrossRefGoogle ScholarPubMed
Huffman, JC, Celano, CM, Januzzi, JLThe relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatr Dis Treat 2010;6:123–136.CrossRefGoogle ScholarPubMed
Iacovides, A, Siamouli, MComorbid mental and somatic disorders: an epidemiological perspective. Curr Opin Psychiatry 2008;21(4):417–421.CrossRefGoogle Scholar
Joffe, H, Cohen, LS, Estrogen, Serotonin and mood disturbance: where is the therapeutic bridge? Biol Psychiatry 1998;44(9):798–811.CrossRefGoogle ScholarPubMed
Järvelin, MR, Sovio, U, King, V, Lauren, L, Xu, B, McCarthy, MI, et al.Early life factors and blood pressure at age 31 years in the 1966 northern Finland birth cohort. Hypertension 2004;44(6):838–846.CrossRefGoogle ScholarPubMed
Katon, WJClinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 2003;54:216–226.CrossRefGoogle ScholarPubMed
Keskimäki, I, Salinto, M, Aro, SSocioeconomic equity in Finnish hospital care in relation to need. Soc Sci Med 1995;41(3):425–431.CrossRefGoogle Scholar
Koenig, W, Sund, M, Fröchlich, M, Fischer, H-G, Löwel, H, Döring, A, et al.C-reactive Protein, a Sensitive Marker of Inflammation, Predicts Future Risk of Coronary Heart Disease in Initially Healthy Middle-Aged Men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation 1999;99:237–242.CrossRefGoogle ScholarPubMed
Kubzansky, LD, Kawachi, I, Weiss, ST, Sparrow, DAnxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence. Ann Behav Med Spring 1998;20(2):47–58.CrossRefGoogle ScholarPubMed
Kubzansky, LD, Koenen, KCIs posttraumatic stress disorder related to development of heart disease? An update. Clev Clin J Med 2009;76Suppl. 2:S60–S65.CrossRefGoogle ScholarPubMed
von Känel, R, Hepp, U, Kraemer, B, Traber, R, Keel, M, Mica, L, et al.Evidence for low-grade systemic proinflammatory activity in patients with posttraumatic stress disorder. J Psychiatr Res 2007;41(9):744–752.CrossRefGoogle ScholarPubMed
Ladvig, K-H, Marten-Mittag, B, Löwel, H, Döring, A, Koenig, WInfluence of depressive mood on the associations of CRP and obesity in 3205 middle aged healthy men. Brain Behav Immun 2003;17:268–275.Google Scholar
Lehtinen, V, Joukamaa, MEpidemiology of depression: prevalence, risk factors and treatment situation. Acta Psychiatr Scand 1994;377 Suppl.:7–10.CrossRefGoogle ScholarPubMed
Lett, HS, Blumenthal, JA, Babyak, MA, Sherwood, A, Strauman, T, Robins, C, et al.Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med 2004;66:305–315.Google ScholarPubMed
Liukkonen, T, Silvennoinen-Kassinen, S, Jokelainen, J, Räsänen, P, Leinonen, M, Meyer-Rochow, VB, et al.The association between C-reactive protein levels and depression: results from the northern Finland 1966 birth cohort study. Biol Psychiatry 2006;60(8):825–830.CrossRefGoogle ScholarPubMed
Maes, MEvidence for an immune response in major depression: a review and hypothesis. Prog Neuropsychopharmacol Biol Psychiatry 1995;19:11–38.CrossRefGoogle ScholarPubMed
Mantella, RC, Butters, MA, Amico, JA, Mazumdar, S, Rollman, BL, Begley, AE, et al.Salivary cortisol is associated with diagnosis and severity of late-life generalized anxiety disorder. Psychoneuroendocrinology 2008;33(6):773–781.CrossRefGoogle ScholarPubMed
McLeish, AC, Zvolensky, MJ, Marshall, EC, Leyro, TMNegative affectivity as a moderator of the association between smoking status and anxiety sensitivity, anxiety symptoms, and perceived health among young adults. J Nerv Ment Dis 2009;197(2):111–116.CrossRefGoogle ScholarPubMed
Miller, RJ, Sutherland, AG, Hutchison, JD, Alexander, DAC-reactive protein and interleukin 6 reseptor in post-traumatic stress disorder: a pilot study. Cytokine 2001;13(4):253–255.CrossRefGoogle Scholar
Mollica, RF, Wyshak, G, de Marneffe, D, Khuon, F, Lavelle, JIndochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psych 1987;144(4):497–500.Google ScholarPubMed
Nettelbladt, P, Hansson, L, Stefansson, CG, Borgquist, L, Nordström, GTest characteristics of the Hopkins Symptom Check List-25 (HSCL-25) in Sweden, using the Present State Examination (PSE-9) as a caseness criterion. Soc Psychiatry Psychiatr Epidemiol 1993;28(3):130–133.CrossRefGoogle Scholar
Odgers, CL, Caspi, A, Broadbent, JM, Dickson, N, Hancox, RJ, Harrington, H, et al.Prediction of differential adult health burden by conduct problem subtypes in males. Arch Gen Psychiatry 2007;64:476–483.CrossRefGoogle ScholarPubMed
Otte, CIncomplete remission in depression: role of psychiatric and somatic comorbidity. Dialogues Clin Neurosci 2008;10(4):453–460.Google ScholarPubMed
Paluska, SA, Schwenk, TLPhysical activity and mental health: current concepts. Sports Med 2000;29(3):167–180.CrossRefGoogle ScholarPubMed
Parashar, S, Rumsfeld, JS, Spertus, JA, Reid, KJ, Wenger, NK, Krumholz, HM, et al.Time course of depression and outcome of myocardial infarction. Arch Intern Med 2006;166:2035–2043.CrossRefGoogle ScholarPubMed
Pariante, CM, Lightman, SLThe HPA axis in major depression: classical theories and new developments. Trends Neurosci 2008;31(9):464–468.CrossRefGoogle ScholarPubMed
Pasco, JA, Berk, M, Henry, MJ, Williams, LJ, Jacka, FN, Kotowicz, MAet al. High sensitivity C-reactive protein and risk of major depression: a 10-year cohort study. XII. IFPE International Congress, Vienna, 2009; April 16–19.Google Scholar
Pearson, TA, Mensah, GA, Alexander, RW, Anderson, JL, Cannon, RO, Criqui, M, et al.Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for Healthcare Professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499–511.CrossRefGoogle ScholarPubMed
Penninx, BWJH, Kritchevsky, SB, Yaffe, K, Newman, AB, Simonsick, EM, Rubin, S, et al.Inflammatory markers and depressed mood in older persons: results from the Health, Aging and Body Composition Study. Biol Psychiatry 2003;54:566–572.CrossRefGoogle ScholarPubMed
Pigott, TAGender differences in the epidemiology and treatment of anxiety disorders. J Clin Psychiatry 1999;60(Suppl. 18):4–15.Google ScholarPubMed
Pitsavos, C, Panagiotakos, DB, Papageorgiou, C, Tsetsekou, E, Soldatos, C, Stefanadis, CAnxiety in relation to inflammation and coagulation markers, among healthy adults: the ATTICA study. Atherosclerosis 2006;185:320–326.CrossRefGoogle ScholarPubMed
Pradhan, AD, Manson, JE, Rifai, N, Buring, JE, Ridker, PMC-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001;286(3):327–334.CrossRefGoogle ScholarPubMed
Pratt, LA, Ford, DE, Crum, RM, Armenian, HK, Gallo, JJ, Eaton, WWDepression, psychotropic medication, and risk of myocardial infarction: prospective data from the Baltimore ECA follow-up. Circulation 1991;94:3123–3129.CrossRefGoogle Scholar
Rantakallio, PGroups at risk in low birth weight infants and perinatal mortality. Acta Paediatrica Scandinavica 1969;193 Suppl.:1–71.Google ScholarPubMed
Rantakallio, PThe longitudinal study of the Northern Finland birth cohort of 1966. Pediatr Perinat Epidemiol 1988;2:59–88.CrossRefGoogle ScholarPubMed
Reichenberg, A, Yirmiya, R, Schuld, A, Kraus, T, Haack, M, Morag, A, et al.Cytokine-associated emotional and cognitive disturbances in humans. Arch Gen Psychiatry 2001;58:445–452.CrossRefGoogle ScholarPubMed
Roberts, RE, Kaplan, GA, Shema, SJ, Strawbridge, WJAre the obese at greater risk for depression? Am J Epidemiol 2000;152:163–170.CrossRefGoogle ScholarPubMed
Rocca, WA, Grossardt, BR, Geda, YE, Gostout, BS, Bower, JH, Maraganore, DM, et al.Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy. Menopause 2008;15(6):1050–1059.CrossRefGoogle ScholarPubMed
Roy, A, DeJong, J, Lamparski, D, George, T, Linnoila, MDepression among alcoholics. Relationship to clinical and cerebrospinal fluid variables. Arch Gen Psychiatry 1991;48:428–432.CrossRefGoogle ScholarPubMed
Sandanger, I, Moum, T, Ingebrigtsen, G, Dalgard, OS, Sørensen, T, Bruusgaard, DConcordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I. Soc Psychiatry Psychiat Epidemiol 1998;33(7):345–354.CrossRefGoogle ScholarPubMed
Sillanaukee, P, van der Gaag, MS, Sierksma, A, Hendriks, HF, Strid, N, Pönniö, M, et al.Effect of type of alcoholic beverages on carbohydrate-deficient transferrin, sialic acid, and liver enzymes. Alcohol Clin Exp Res 2003;27(1):57–60.CrossRefGoogle ScholarPubMed
Solomon, MB, Herman, JPSex differences in psychopathology: of gonads, adrenals and mental illness. Physiol Behav 2009;2597(2)250–258.CrossRefGoogle Scholar
Sorri, M, Järvelin, MRWell-being and health. Background to the Northern Finland 1966 birth cohort research. Int J Circumpolar Health 1998;57:82–83.Google ScholarPubMed
Sperner-Unterweger, BImmunological aetiology of major psychiatric disorders: evidence and therapeutic implications. Drugs 2005;65(11):1493–1520.CrossRefGoogle ScholarPubMed
Stewart, JC, Rand, KL, Muldoon, MF, Kamarck, TWA prospective evaluation of the directionality of the depression-inflammation relationship Brain. Behav Immun 2009;23(7):936–944.CrossRefGoogle Scholar
Söndergaard, HP, Hansson, LO, Theorell, TThe inflammatory markers C-reactive protein and serum amyloid A in refugees with and without posttraumatic stress disorder. Clin Chim Acta 2004;342(1–2):93–98.CrossRefGoogle ScholarPubMed
Taponen, S, Martikainen, H, Jarvelin, MR, Sovio, U, Laitinen, J, Pouta, A, et al.Metabolic cardiovascular disease risk factors in women with self-reported symptoms of oligomenorrhea and/or hirsutism: Northern Finland Birth Cohort 1966 Study. J Clin Endocrinol Metab 2004;89:2114–2118.CrossRefGoogle ScholarPubMed
Tzoulaki, I, Jarvelin, MR, Hartikainen, AL, Leinonen, M, Pouta, A, Paldanius, MSize at birth, weight gain over the life course, and low-grade inflammation in young adulthood: northern Finland 1966 Birth Cohort study. Eur Heart J 2008;29(8):1049–1056.CrossRefGoogle ScholarPubMed
Veen, G, Derijk, RH, Giltay, EJ, van Vliet, IM, van Pelt, J, Zitman, FGThe influence of psychiatric comorbidity on the dexamethasone/CRH test in major depression. Eur Neuropsychopharmacol 2009;19(6):409–415.CrossRefGoogle ScholarPubMed
Williams, MJA, Williams, SM, Milne, BJ, Hancox, RJ, Poulton, RAssosiation between C-reactive protein, metabolic cardiovascular risk factors, obesity and oral contraceptive use in young adults. Int J Obes Relat Metab Disord 2004;28(8):998–1003.CrossRefGoogle Scholar
Winokur, A, Winokur, DF, Rickels, K, Cox, DSSymptoms of emotional distress in a family planning service: stability over a four-week period. Br J Psychiatry 1984;144:395–399.CrossRefGoogle Scholar
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