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Meta-Analysis
. 2012 Jul 31:345:e4933.
doi: 10.1136/bmj.e4933.

Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies

Tom C Russ  1 , Emmanuel Stamatakis, Mark Hamer, John M Starr, Mika Kivimäki, G David Batty
Affiliations
Meta-Analysis

Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies

Tom C Russ et al. BMJ. .

Abstract

Objective: To quantify the link between lower, subclinically symptomatic, levels of psychological distress and cause-specific mortality in a large scale, population based study.

Design: Individual participant meta-analysis of 10 large prospective cohort studies from the Health Survey for England. Baseline psychological distress measured by the 12 item General Health Questionnaire score, and mortality from death certification.

Participants: 68,222 people from general population samples of adults aged 35 years and over, free of cardiovascular disease and cancer, and living in private households in England at study baseline.

Main outcome measures: Death from all causes (n = 8365), cardiovascular disease including cerebrovascular disease (n = 3382), all cancers (n = 2552), and deaths from external causes (n = 386). Mean follow-up was 8.2 years (standard deviation 3.5).

Results: We found a dose-response association between psychological distress across the full range of severity and an increased risk of mortality (age and sex adjusted hazard ratio for General Health Questionnaire scores of 1-3 v score 0: 1.20, 95% confidence interval 1.13 to 1.27; scores 4-6: 1.43, 1.31 to 1.56; and scores 7-12: 1.94, 1.66 to 2.26; P<0.001 for trend). This association remained after adjustment for somatic comorbidity plus behavioural and socioeconomic factors. A similar association was found for cardiovascular disease deaths and deaths from external causes. Cancer death was only associated with psychological distress at higher levels.

Conclusions: Psychological distress is associated with increased risk of mortality from several major causes in a dose-response pattern. Risk of mortality was raised even at lower levels of distress.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow chart of participants from initial pooled sample to analytic sample showing subsequent mortality
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Fig 2 Number of participants, total mortality, and deaths plus age and sex adjusted hazard ratios (95% confidence intervals) per standard deviation disadvantage in GHQ-12 score, by survey year and cause of death
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Fig 3 Association between psychological distress (GHQ-12 score) and risk of cause specific death (age and sex adjusted hazard ratio (95% confidence interval)). Reference=GHQ-12 score 0; higher GHQ-12 score indicates greater distress
See this image and copyright information in PMC

Comment in

References

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