Negative emotions and coronary heart disease: causally related or merely coexistent? A review.

Negative emotions have been claimed to be a cause of coronary heart disease (CHD) as well as a consequence of cardiovascular disorders. Early case studies of cardiac disorders of soldiers in battle drew attention to the possibility that strong negative emotional states could cause CHD. Subsequent reports of reactions to natural disasters supported the notion that intense negative emotions could precipitate somatic disorders such as CHD. Since then, numerous studies have investigated relations between negative emotions and CHD. Over the years, retrospective studies have found, for example, that negative emotions are often present before the occurrence of CHD. Cross-sectional studies have indicated that symptoms of depression and anxiety are often present in CHD patients. Prospective studies have shown that the likelihood of CHD tends to be higher for people with negative emotions than for those without them. The main symptoms of negative emotional states that seem to be most closely associated with CHD are nervousness, getting easily upset, feeling fatigue, being indecisive, having sleep disturbances, being usually worried about something, and feeling that others would be better off if oneself were dead. Although the findings appear to support the notion of causal connections between negative emotions and CHD, they fail to provide conclusive proof of such relations. An alternative explanation that could also account for the findings is simply that negative emotions and CHD often coexist.