Psychosocial factors in relation to coronary heart disease in South Asians: a systematic review

Background: People of South Asia descent in the UK have high coronary heart disease (CHD) risk. Psychosocial factors affect the risk of CHD, independent of ethnicity. Factors such as stress, depression and anxiety are postulated to be predictors of heart disease. The objectives of this review were to systematically review quantitative research on psychosocial factors and CHD in South Asians in Europe and North America to answer the question: What is the relation between psychosocial factors and CHD in South Asians residing in Europe and North America? Methods: A systematic literature review was conducted according to the recommendations of the Centre for Reviews and Dissemination and the PRISMA guidelines. Electronic databases were searched using relevant terms and data were extracted into data extraction forms. The quality assessment criteria were adapted from the National Institute for Health and Clinical Excellence (NICE) guidance 2009. A narrative review was planned. Results: Five cross-sectional studies and their associated eight papers were included. The studies varied with reference to the age of samples, psychosocial factors and in reporting. For depression, four studies showed increased levels in South Asian population compared to the White population. Two studies reported low optimism present in South Asians compared to the general population. Four out of five studies showed lower social support in South Asian men in comparison to the general population. One study found that South Asians had low control and high social support at work compared to the White population. One study showed no differences in work strain. Conclusions: The evidence was limited but indicated psychosocial risk factors were commoner in South Asians compared to the general population. New, large scale, especially prospective studies should explore this.