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Open Access Research article

Ethnic differences in the association between cardiovascular risk factors and psychological distress in a population study in the Netherlands

Agnes C Schrier1*, Joanne K Ujcic-Voortman2, Matty AS de Wit2, Arnoud P Verhoeff23, Ralph Kupka14, Jack Dekker56 and Aartjan TF Beekman46

Author Affiliations

1 Altrecht Institute for Mental Health Care, Utrecht, The Netherlands

2 Department of Epidemiology, Public Health Service Amsterdam, Documentation and Health Promotion, Amsterdam, The Netherlands

3 Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, the Netherlands

4 Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands

5 Department of Clinical Psychology, VU University Medical Center, Amsterdam, The Netherlands

6 VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands

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BMC Public Health 2012, 12:1090  doi:10.1186/1471-2458-12-1090

Published: 18 December 2012



There is growing body of evidence of an association between cardiovascular risk factors and depressive and anxiety symptoms. The purpose of this study was to investigate whether these associations are similar in ethnic minority groups.


A random urban population sample, aged 18+, stratified by ethnicity (484 native Dutch subjects, 383 Turkish-Dutch subjects, and 316 Moroccan-Dutch subjects), in Amsterdam, the Netherlands, was interviewed with the Kessler Psychological Distress scale (K10) in combination with measurements of several cardiovascular risk factors. The association of psychological distress (defined as a K10 score above cut-off of 20) with cardiovascular risk factors (obesity, abdominal obesity, hypertension, hypercholesterolemia, low HDL cholesterol levels or diabetes), ethnicity and their interaction was analyzed using logistic regression analyses, stratified by gender and adjusted for age.


Cardiovascular risk factors were not significantly associated with psychological distress in any of the gender/ethnic groups, with the exception of a positive association of obesity and hypertension with psychological distress in native Dutch women and a negative association of hypertension and psychological distress in Turkish men. Interaction terms of cardiovascular risk factors and ethnicity were approaching significance only in the association of obesity with the K10 in women.


In this cross-sectional multi-ethnic adult population sample the majority of the investigated cardiovascular risk factors were not associated with psychological distress. The association of obesity with psychological distress varies by gender and ethnicity. Our findings indicate that the prevention of obesity and psychological distress calls for an integrated approach in native Dutch women, but not necessarily in Turkish-Dutch and Moroccan-Dutch women, in whom these problems may be targeted separately.

Obesity; Cardiovascular; Depression; Ethnicity; Epidemiology