SpringerLink
Log in

The Relationship Between Psychological Distress and Bio-behavioral Processes in Cardiovascular Disease

  • Living reference work entry
  • First Online:
Brain and Heart Dynamics

Abstract

Cardiovascular disease (CVD) has been proven to be the largest contributor to morbidity and mortality in the developed world. By considering the psychosocial factors that have been linked to CVD, this chapter will focus on the role of psychological distress. Existing empirical evidence shows that stress can be considered as a risk factor starting from the early years, while in adulthood the risk associated with distress derives mainly from either social isolation or workplace-related chronic stressors. Both behavioral and neurobiological mechanisms have been proposed to underlie this association, including sustained activation of the sympathetic nervous system and reduced heart rate variability. Finally, we report research emphasizing the potential protective role of positive psychological constructs such as well-being, optimism, and positive affect.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. Kelly BB, Fuster V. Promoting cardiovascular health in the develo** world: a critical challenge to achieve global health. Washington, DC: National Academies Press; 2010.

    Google Scholar 

  2. Rosmond R, Bjorntorp P. The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med. 2000;247(2):188–97.

    Article  CAS  PubMed  Google Scholar 

  3. Ofori SN, Odia OJ. Risk assessment in the prevention of cardiovascular disease in low-resource settings. Indian Heart J. 2016;68(3):391–8.

    Article  PubMed  Google Scholar 

  4. Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012;9(6):360–70.

    Article  CAS  PubMed  Google Scholar 

  5. de Goma EM, Knowles JW, Angeli F, Budoff MJ, Rader DJ. The evolution and refinement of traditional risk factors for cardiovascular disease. Cardiol Rev. 2012;20(3):118–29.

    Article  Google Scholar 

  6. Balagopal P, de Ferranti SD, Cook S, Daniels SR, Gidding SS, Hayman LL, et al. Nontraditional risk factors and biomarkers for cardiovascular disease: mechanistic, research, and clinical considerations for youth: a scientific statement from the American Heart Association. Circulation. 2011;123(23):2749–69.

    Article  PubMed  Google Scholar 

  7. Shaima C, Moorthi P, Shaheen N. Cardiovascular diseases: traditional and non-traditional risk factors. J Med Allied Sci. 2016;6(2):46.

    Article  Google Scholar 

  8. Hering D, Lachowska K, Schlaich M. Role of the sympathetic nervous system in stress-mediated cardiovascular disease. Curr Hypertens Rep. 2015;17(10):80.

    Article  PubMed  CAS  Google Scholar 

  9. Ferketich AK, Binkley PF. Psychological distress and cardiovascular disease: results from the 2002 National Health Interview Survey. Eur Heart J. 2005;26(18):1923–9.

    Article  PubMed  Google Scholar 

  10. Chauvet-Gelinier J-C, Bonin B. Stress, anxiety and depression in heart disease patients: a major challenge for cardiac rehabilitation. Ann Phys Rehabil Med. 2017;60(1):6–12.

    Article  PubMed  Google Scholar 

  11. Denollet J, Schiffer AA, Spek V. A general propensity to psychological distress affects cardiovascular outcomes: evidence from research on the type D (distressed) personality profile. Circ Cardiovasc Qual Outcomes. 2010;3(5):546–57.

    Article  PubMed  Google Scholar 

  12. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99(16):2192–217.

    Article  CAS  PubMed  Google Scholar 

  13. Selye H. Endocrine reactions during stress.∗. Anesth Analg. 1956;35(3):182–93.

    Article  CAS  Google Scholar 

  14. Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009;5(7):374–81.

    Article  CAS  PubMed  Google Scholar 

  15. Cannon WB. The wisdom of the body. New York: WW Norton and Company; 1939.

    Book  Google Scholar 

  16. Day TA. Defining stress as a prelude to map** its neurocircuitry: no help from allostasis. Prog Neuro-Psychopharmacol Biol Psychiatry. 2005;29(8):1195–200.

    Article  Google Scholar 

  17. Levine S. Developmental determinants of sensitivity and resistance to stress. Psychoneuroendocrinology. 2005;30(10):939–46.

    Article  PubMed  Google Scholar 

  18. Armario A. The hypothalamic-pituitary-adrenal axis: what can it tell us about stressors? CNS Neurol Disord Drug Targets. 2006;5(5):485–501.

    Article  PubMed  Google Scholar 

  19. Koolhaas JM, Bartolomucci A, Buwalda B, de Boer SF, Flügge G, Korte SM, et al. Stress revisited: a critical evaluation of the stress concept. Neurosci Biobehav Rev. 2011;35(5):1291–301.

    Article  CAS  PubMed  Google Scholar 

  20. Lazarus RS. Psychological stress and the co** process. New York: McGraw-Hill; 1966.

    Google Scholar 

  21. Somerfield MR, McCrae RR. Stress and co** research: methodological challenges, theoretical advances, and clinical applications. Am Psychol. 2000;55(6):620–5.

    Article  CAS  PubMed  Google Scholar 

  22. Lazarus RS. Emotions and interpersonal relationships: toward a person-centered conceptualization of emotions and co**. J Pers. 2006;74(1):9–46.

    Article  PubMed  Google Scholar 

  23. von Känel R, Mausbach BT, Dimsdale JE, Mills PJ, Patterson TL, Ancoli-Israel S, et al. Ways of co** and biomarkers of an increased Atherothrombotic cardiovascular disease risk in elderly individuals. Cardiovasc Psychiatry Neurol. 2012;2012:1–9.

    Article  Google Scholar 

  24. Kemeny ME. The psychobiology of stress. Curr Dir Psychol Sci. 2003;12(4):124–9.

    Article  Google Scholar 

  25. Salvador A. Co** with competitive situations in humans. Neurosci Biobehav Rev. 2005;29(1):195–205.

    Article  PubMed  Google Scholar 

  26. Seidel E-M, Pfabigan DM, Hahn A, Sladky R, Grahl A, Paul K, et al. Uncertainty during pain anticipation: the adaptive value of preparatory processes: uncertainty during pain anticipation. Hum Brain Mapp. 2015;36(2):744–55.

    Article  PubMed  Google Scholar 

  27. Yoshida W, Seymour B, Koltzenburg M, Dolan RJ. Uncertainty increases pain: evidence for a novel mechanism of pain modulation involving the periaqueductal gray. J Neurosci. 2013;33(13):5638–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Rojo-Moreno L, Livianos-Aldana L, Cervera-Martínez G, Dominguez-Carabantes JA, Reig-Cebrian MJ. The role of stress in the onset of depressive disorders. Soc Psychiatry Psychiatr Epidemiol. 2002;37(12):592–8.

    Article  CAS  PubMed  Google Scholar 

  29. Steptoe A, Kivimäki M. Stress and cardiovascular disease: an update on current knowledge. Annu Rev Public Health. 2013;34(1):337–54.

    Article  PubMed  Google Scholar 

  30. Rosengren A, Hawken S, Ôunpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–62.

    Article  PubMed  Google Scholar 

  31. Costa PT, McCrae RR. The revised neo personality inventory (neo-pi-r). The SAGE handbook of personality theory and assessment. 2008;2(2):179–198.

    Google Scholar 

  32. Watson D, Clark LA. Negative affectivity: the disposition to experience aversive emotional states. Psychol Bull. 1984;96(3):465–90.

    Article  CAS  PubMed  Google Scholar 

  33. Alastalo H, Räikkönen K, Pesonen A-K, Osmond C, Barker DJP, Heinonen K, et al. Early life stress and blood pressure levels in late adulthood. J Hum Hypertens. 2013;27(2):90–4.

    Article  CAS  PubMed  Google Scholar 

  34. Low CA, Salomon K, Matthews KA. Chronic life stress, cardiovascular reactivity, and subclinical cardiovascular disease in adolescents. Psychosom Med. 2009;71(9):927–31.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Parrish C, Surkan PJ, Martins SS, Gattaz WF, Andrade LH, Viana MC. Childhood adversity and adult onset of hypertension and heart disease in São Paulo, Brazil. Prev Chronic Dis. 2013;10:130193.

    Article  Google Scholar 

  36. Su S, Wang X, Pollock JS, Treiber FA, Xu X, Snieder H, et al. Adverse childhood experiences and blood pressure trajectories from childhood to young adulthood: the Georgia stress and heart study. Circulation. 2015;131(19):1674–81.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wegman HL, Stetler C. A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosom Med. 2009;71(8):805–12.

    Article  PubMed  Google Scholar 

  38. Scott KM. Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Arch Gen Psychiatry. 2011;68(8):838.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Power C, Hyppönen E, Davey Smith G. Socioeconomic position in childhood and early adult life and risk of mortality: a prospective study of the mothers of the 1958 British birth cohort. Am J Public Health. 2005;95(8):1396–402.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Garner AS, Shonkoff JP, Siegel BS, Dobbins MI, Earls MF, McGuinn L, et al. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012;129(1):e224–e31.

    Article  PubMed  Google Scholar 

  41. Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, et al. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation. 2004;110(13):1761–6.

    Article  PubMed  Google Scholar 

  42. Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Väänänen A, Vahtera J. Work stress in the etiology of coronary heart disease—a meta-analysis. Scand J Work Environ Health. 2006;32(6):431–42.

    Article  PubMed  Google Scholar 

  43. Schnall PL, Schwartz JE, Landsbergis PA, Warren K, Pickering TG. A longitudinal study of job strain and ambulatory blood pressure: results from a three-year follow-up. Psychosom Med. 1998;60(6):697–706.

    Article  CAS  PubMed  Google Scholar 

  44. Theorell T, Perski A, Akerstedt T, Sigala F, Ahlberg-Hulten G, Svensson J, et al. Changes in job strain in relation to changes in physiological state. A longitudinal study. Scand J Work Environ Health. 1988;14(3):189–96.

    Article  CAS  PubMed  Google Scholar 

  45. Freeman LJ, Nixon PGF, Sallabank P, Reaveley D. Psychological stress and silent myocardial ischemia. Am Heart J. 1987;114(3):477–82.

    Article  CAS  PubMed  Google Scholar 

  46. Rosengren A, Orth-Gomer K, Wedel H, Wilhelmsen L. Stressful life events, social support, and mortality in men born in 1933. BMJ. 1993;307(6912):1102–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Pignalberi C, Patti G, Chimenti C, Pasceri V, Maseri A. Role of different determinants of psychological distress in acute coronary syndromes. J Am Coll Cardiol. 1998;32(3):613–9.

    Article  CAS  PubMed  Google Scholar 

  48. Virtanen M, Heikkila K, Jokela M, Ferrie JE, Batty GD, Vahtera J, et al. Long working hours and coronary heart disease: a systematic review and meta-analysis. Am J Epidemiol. 2012;176(7):586–96.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ruberman W, Weinblatt E, Goldberg JD, Chaudhary BS. Psychosocial influences on mortality after myocardial infarction. N Engl J Med. 1984;311(9):552–9.

    Article  CAS  PubMed  Google Scholar 

  50. McPherson M, Smith-Lovin L, Brashears ME. Social isolation in America: changes in core discussion networks over two decades. Am Sociol Rev. 2006;71(3):353–75.

    Article  Google Scholar 

  51. Berkman LF. Emotional support and survival after myocardial infarction: a prospective, population-based study of the elderly. Ann Intern Med. 1992;117(12):1003.

    Article  CAS  PubMed  Google Scholar 

  52. House JS, Robbins C, Metzner HL. The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community health study. Am J Epidemiol. 1982;116(1):123–40.

    Article  CAS  PubMed  Google Scholar 

  53. Welin L, Larsson B, Svardsudd K, Tibblin B, Tibblin G. Social network and activities in relation to mortality from cardiovascular diseases, cancer and other causes: a 12 year follow up of the study of men born in 1913 and 1923. J Epidemiol Community Health. 1992;46(2):127–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Penley JA, Tomaka J, Wiebe JS. The association of co** to physical and psychological health outcomes: a meta-analytic review. J Behav Med. 2002;25(6):551–603.

    Article  PubMed  Google Scholar 

  55. Stewart MJ, Hirth AM, Klassen G, Makrides L, Wolf H. Stress, co**, and social support as psychosocial factors in readmissions for ischaemic heart disease. Int J Nurs Stud. 1997;34(2):151–63.

    Article  CAS  PubMed  Google Scholar 

  56. Merz CNB, Dwyer J, Nordstrom CK, Walton KG, Salerno JW, Schneider RH. Psychosocial stress and cardiovascular disease: pathophysiological links. Behav Med. 2002;27(4):141–7.

    Article  Google Scholar 

  57. Chandola T, Britton A, Brunner E, Hemingway H, Malik M, Kumari M, et al. Work stress and coronary heart disease: what are the mechanisms? Eur Heart J. 2008;29(5):640–8.

    Article  PubMed  Google Scholar 

  58. Kassel JD, Stroud LR, Paronis CA. Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychol Bull. 2003;129(2):270–304.

    Article  PubMed  Google Scholar 

  59. Sinha R. Chronic stress, drug use, and vulnerability to addiction. Ann N Y Acad Sci. 2008;1141(1):105–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition. 2007;23(11–12):887–94.

    Article  PubMed  Google Scholar 

  61. Ulrich-Lai YM, Herman JP. Neural regulation of endocrine and autonomic stress responses. Nat Rev Neurosci. 2009;10(6):397–409.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Burford N, Webster N, Cruz-Topete D. Hypothalamic-pituitary-adrenal Axis modulation of glucocorticoids in the cardiovascular system. Int J Mol Sci. 2017;18(10):2150.

    Article  PubMed Central  CAS  Google Scholar 

  63. Thayer JF, Lane RD. The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psychol. 2007;74(2):224–42.

    Article  PubMed  Google Scholar 

  64. Vrijkotte TGM, van Doornen LJP, de Geus EJC. Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension. 2000;35(4):880–6.

    Article  CAS  PubMed  Google Scholar 

  65. Porges SW. The polyvagal perspective. Biol Psychol. 2007;74(2):116–43.

    Article  PubMed  Google Scholar 

  66. Sharpley CF. Heart rate reactivity and variability as psychophysiological links between stress, anxiety, depression, and cardiovascular disease: implications for health psychology interventions. Aust Psychol. 2002;37(1):56–62.

    Article  Google Scholar 

  67. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol. 2010;141(2):122–31.

    Article  PubMed  Google Scholar 

  68. Masi CM, Hawkley LC, Rickett EM, Cacioppo JT. Respiratory sinus arrhythmia and diseases of aging: obesity, diabetes mellitus, and hypertension. Biol Psychol. 2007;74(2):212–23.

    Article  PubMed  Google Scholar 

  69. Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC. The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation. 1993;88(3):927–34.

    Article  CAS  PubMed  Google Scholar 

  70. Tsuji H, Venditti FJ, Manders ES, Evans JC, Larson MG, Feldman CL, et al. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham heart study. Circulation. 1994;90(2):878–83.

    Article  CAS  PubMed  Google Scholar 

  71. Grossman P, Watkins LL, Wilhelm FH, Manolakis D, Lown B. Cardiac vagal control and dynamic responses to psychological stress among patients with coronary artery disease. Am J Cardiol. 1996;78(12):1424–7.

    Article  CAS  PubMed  Google Scholar 

  72. Lovallo WR. Cardiovascular reactivity: mechanisms and pathways to cardiovascular disease. Int J Psychophysiol. 2005;58(2–3):119–32.

    Article  PubMed  Google Scholar 

  73. Lovallo WR, Gerin W. Psychophysiological reactivity: mechanisms and pathways to cardiovascular disease. Psychosom Med. 2003;65(1):36–45.

    Article  PubMed  Google Scholar 

  74. Schwartz AR, Gerin W, Davidson KW, Pickering TG, Brosschot JF, Thayer JF, et al. Toward a causal model of cardiovascular responses to stress and the development of cardiovascular disease. Psychosom Med. 2003;65(1):22–35.

    Article  PubMed  Google Scholar 

  75. Treiber FA, Kamarck T, Schneiderman N, Sheffield D, Kapuku G, Taylor T. Cardiovascular reactivity and development of preclinical and clinical disease states. Psychosom Med. 2003;65(1):46–62.

    Article  PubMed  Google Scholar 

  76. Menkes MS, Matthews KA, Krantz DS, Lundberg U, Mead LA, Qaqish B, et al. Cardiovascular reactivity to the cold pressor test as a predictor of hypertension. Hypertension. 1989;14(5):524–30.

    Article  CAS  PubMed  Google Scholar 

  77. Kamarck TW, Everson SA, Kaplan GA, Manuck SB, Jennings JR, Salonen R, et al. Exaggerated blood pressure responses during mental stress are associated with enhanced carotid atherosclerosis in middle-aged Finnish men: findings from the Kuopio ischemic heart disease study. Circulation. 1997;96(11):3842–8.

    Article  CAS  PubMed  Google Scholar 

  78. Lynch JW, Everson SA, Kaplan GA, Salonen R, Salonen JT. Does low socioeconomic status potentiate the effects of heightened cardiovascular responses to stress on the progression of carotid atherosclerosis? Am J Public Health. 1998;88(3):389–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Scherer KR, Schorr A, Johnstone T. Appraisal processes in emotion: theory, methods, research. New York: Oxford University Press; 2001.

    Google Scholar 

  80. Phillips ML, Drevets WC, Rauch SL, Lane R. Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol Psychiatry. 2003;54(5):504–14.

    Article  PubMed  Google Scholar 

  81. Bates JE. Temperament as an emotion construct: theoretical and practical issues. In: Handbook of emotions, vol. 2. New York: Guilford Press; 2000. p. 382–96.

    Google Scholar 

  82. Eysenck HJ. Prediction of Cancer and coronary heart disease mortality by means of a personality inventory: results of a 15-year follow-up study. Psychol Rep. 1993;72(2):499–516.

    Article  CAS  PubMed  Google Scholar 

  83. Everson SA, Kaplan GA, Goldberg DE, Salonen JT. Anticipatory blood pressure response to exercise predicts future high blood pressure in middle-aged men. Hypertension. 1996;27(5):1059–64.

    Article  CAS  PubMed  Google Scholar 

  84. alʼAbsi M, Lovallo WR, McKey BS, Pincomb GA. Borderline hypertensives produce exaggerated adrenocortical responses to mental stress. Psychosom Med. 1994;56(3):245–50.

    Article  PubMed  Google Scholar 

  85. Mills PJ, Dimsdale JE, Ziegler MG, Berry CC, Bain RD. Beta-adrenergic receptors predict heart rate reactivity to a psychosocial stressor. Psychosom Med. 1990;52(6):621–3.

    Article  CAS  PubMed  Google Scholar 

  86. Seligman MEP, Csikszentmihalyi M. Positive psychology: an introduction. Am Psychol. 2000;55(1):5–14.

    Article  CAS  PubMed  Google Scholar 

  87. Ryff CD, Dienberg Love G, Urry HL, Muller D, Rosenkranz MA, Friedman EM, et al. Psychological well-being and ill-being: do they have distinct or mirrored biological correlates? Psychother Psychosom. 2006;75(2):85–95.

    Article  PubMed  Google Scholar 

  88. Boehm JK, Kubzansky LD. The heart’s content: the association between positive psychological well-being and cardiovascular health. Psychol Bull. 2012;138(4):655–91.

    Article  PubMed  Google Scholar 

  89. Scheier MF, Carver CS. Optimism, co**, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 1985;4(3):219–47.

    Article  CAS  PubMed  Google Scholar 

  90. Giltay EJ, Geleijnse JM, Zitman FG, Hoekstra T, Schouten EG. Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly Dutch men and women. Arch Gen Psychiatry. 2004;61(11):1126.

    Article  PubMed  Google Scholar 

  91. Kim ES, Park N, Peterson C. Dispositional optimism protects older adults from stroke: the health and retirement study. Stroke. 2011;42(10):2855–9.

    Article  PubMed  Google Scholar 

  92. Scheier MF, Matthews KA, Owens JF, Magovern GJ, Lefebvre RC, Abbott RA, et al. Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being. J Pers Soc Psychol. 1989;57(6):1024–40.

    Article  CAS  PubMed  Google Scholar 

  93. Kim ES, Smith J, Kubzansky LD. Prospective study of the association between dispositional optimism and incident heart failure. Circ Heart Fail. 2014;7(3):394–400.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Boehm JK, Williams DR, Rimm EB, Ryff C, Kubzansky LD. Association between optimism and serum antioxidants in the midlife in the United States study. Psychosom Med. 2013;75(1):2–10.

    Article  CAS  PubMed  Google Scholar 

  95. Boehm JK, Peterson C, Kivimaki M, Kubzansky L. A prospective study of positive psychological well-being and coronary heart disease. Health Psychol. 2011;30(3):259–67.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Kubzansky LD, Thurston RC. Emotional vitality and incident coronary heart disease: benefits of healthy psychological functioning. Arch Gen Psychiatry. 2007;64(12):1393.

    Article  PubMed  Google Scholar 

  97. Davidson KW, Mostofsky E, Whang W. Don’t worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia health survey. Eur Heart J. 2010;31(9):1065–70.

    Article  PubMed  PubMed Central  Google Scholar 

  98. DuBois CM, Lopez OV, Beale EE, Healy BC, Boehm JK, Huffman JC. Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: a systematic review. Int J Cardiol. 2015;195:265–80.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy

    Stefania Balzarotti

  2. Neuroscience Lab, Champlain College, Burlington, VT, USA

    Barbara Colombo & Amanda Christensen

Authors
  1. Stefania Balzarotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barbara Colombo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amanda Christensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara Colombo .

Editor information

Editors and Affiliations

  1. Dept of Drug Sciences, Pharmacology Sect, University of Pavia, Dept of Drug Sciences, Pharmacology Sect, Pavia, Pavia, Italy

    Stefano Govoni

  2. Dept of Brain and Behavioural Sciences, University of Pavia Dept of Brain and Behavioural Sciences, Pavia, Pavia, Italy

    Pierluigi Politi

  3. Department of Molecular Medicine, University of Pavia, Department of Molecular Medicine, Pavia, Pavia, Italy

    Emilio Vanoli

Section Editor information

  1. Dipartimento di Medicina Clinica e Sperimentale, Unità di Psichiatria, Università degli Studi di Catania, Catania, Italy

    Laura Fusar-Poli

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Balzarotti, S., Colombo, B., Christensen, A. (2019). The Relationship Between Psychological Distress and Bio-behavioral Processes in Cardiovascular Disease. In: Govoni, S., Politi, P., Vanoli, E. (eds) Brain and Heart Dynamics. Springer, Cham. https://doi.org/10.1007/978-3-319-90305-7_14-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90305-7_14-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90305-7

  • Online ISBN: 978-3-319-90305-7

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation