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Meta-Analysis
. 2017 Jan 25:356:j108.
doi: 10.1136/bmj.j108.

Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies

G David Batty  1 , Tom C Russ  2   3 , Emmanuel Stamatakis  4 , Mika Kivimäki  5
Affiliations
Meta-Analysis

Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies

G David Batty et al. BMJ. .

Abstract

Objective: To examine the role of psychological distress (anxiety and depression) as a potential predictor of site specific cancer mortality.

Design: Pooling of individual participant data from 16 prospective cohort studies initiated 1994-2008.

Setting: Nationally representative samples drawn from the health survey for England (13 studies) and the Scottish health survey (three studies).

Participants: 163 363 men and women aged 16 or older at study induction, who were initially free of a cancer diagnosis, provided self reported psychological distress scores (based on the general health questionnaire, GHQ-12) and consented to health record linkage.

Main outcome measure: Vital status records used to ascertain death from 16 site specific malignancies; the three Scottish studies also had information on cancer registration (incidence).

Results: The studies collectively contributed an average of 9.5 years of mortality surveillance during which there were 16 267 deaths (4353 from cancer). After adjustment for age, sex, education, socioeconomic status, body mass index (BMI), and smoking and alcohol intake, and with reverse causality (by left censoring) and missing data (by imputation) taken into account, relative to people in the least distressed group (GHQ-12 score 0-6), death rates in the most distressed group (score 7-12) were consistently raised for cancer of all sites combined (multivariable adjusted hazard ratio 1.32, 95% confidence interval 1.18 to 1.48) and cancers not related to smoking (1.45, 1.23 to 1.71), as well as carcinoma of the colorectum (1.84, 1.21 to 2.78), prostate (2.42, 1.29 to 4.54), pancreas (2.76, 1.47 to 5.19), oesophagus (2.59, 1.34 to 5.00), and for leukaemia (3.86, 1.42 to 10.5). Stepwise associations across the full range of distress scores were observed for colorectal and prostate cancer.

Conclusion: This study contributes to the growing evidence that psychological distress might have some predictive capacity for selected cancer presentations, in addition to other somatic diseases.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf 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 three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Study members from induction through to sample for analysis: follow-up of 16 cohort studies from health survey for England and Scottish health survey (n=163 363). People excluded can fall into more than one category so total exceeds 36 141
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Fig 2 Hazard ratios (95% confidence intervals) for psychological distress in relation to mortality from all cancers combined according to study: follow-up of 16 cohort studies from health survey for England (HSE) and Scottish health survey (SHS) (n=163 363). Hazard ratios (adjusted for age and sex) are for psychological distress score of 7-12 (most distressed) relative to 0-6. I2=2%
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Fig 3 Hazard ratios (95% confidence interval) for psychological distress in relation to selected cancer death outcomes: follow-up of 16 cohort studies from health survey for England and Scottish health survey (n=163 363). Hazard ratios are for psychological distress score of 7-12 (most distressed) relative to 0-6, and are age and—except in single sex analyses—sex adjusted (I2=15%), or multivariable adjusted (age, sex, BMI, educational attainment, smoking status, and alcohol consumption; I2=37%)
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Fig 4 Hazard ratios (95% confidence interval) for psychological distress in relation to selected cancer outcomes: comparison of effects for incidence and mortality in follow-up of three cohort studies from Scottish health survey (SHS; n=20 485). Hazard ratios (adjusted for age and sex) are for psychological distress score of 7-12 (most distressed) relative to 0-6. Individuals with cancers registered before baseline (n=696) were excluded from analyses of cancer incidence
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