The Combined Association of Psychological Distress and Socioeconomic Status With All-Cause Mortality: A National Cohort Study
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BACKGROUND: Psychological distress and low socioeconomic status (SES) are recognized risk factors for mortality. The aim of this study was to test whether lower SES amplifies the effect of psychological distress on all-cause mortality. METHODS: We selected 66 518 participants from the Health Survey for England who were 35 years or older, free of cancer and cardiovascular disease at baseline, and living in private households in England from 1994 to 2004. Selection used stratified random sampling, and participants were linked prospectively to mortality records from the Office of National Statistics (mean follow-up, 8.2 years). Psychological distress was measured using the 12-item General Health Questionnaire, and SES was indexed by occupational class. RESULTS: The crude incidence rate of death was 14.49 (95% CI, 14.17-14.81) per 1000 person-years. After adjustment for age and sex, psychological distress and low SES category were associated with increased mortality rates. In a stratified analysis, the association of psychological distress with mortality differed with SES (likelihood ratio test-adjusted P < .001), with the strongest associations being observed in the lowest SES categories. CONCLUSIONS: The detrimental effect of psychological distress on mortality is amplified by low SES category. People in higher SES categories have lower mortality rates even when they report high levels of psychological distress.
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Studies have reported stronger associations of presumably adaptive and maladaptive dispositions with physical functioning and mortality at lower levels of SES, thereby contributing to smaller or larger socioeconomic gradients.
“Consistent with the vulnerability model, studies have reported stronger associations of presumably adaptive (e.g., perceived control) and maladaptive (e.g., neuroticism and negative affectivity) dispositions with physical functioning and mortality at lower levels of SES, thereby contributing to smaller or larger socioeconomic gradients (33-36).”
From Socioeconomic Status Interacts with Conscientiousness and Neuroticism to Predict Circulating Concentrations of Inflammatory Markers (2017) · cites this paper as [34]
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Choi, J., & Cho, S. (2025) · medRxiv · doi:10.1101/2025.05.01.25326837
- Authors
- Lazzarino, A. I., Hamer, M., Stamatakis, E., & Steptoe, A.
- Affiliations
- University College London (GB)
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2013-01-14
- Volume
- 173
- Issue
- 1
- Pages
- 22
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2000273503
- Cited by
- 81
- References
- 27
- Citations by year
- 2025: 2 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 9 · 2018: 9 · 2017: 4 · 2016: 9 · 2015: 12 · 2014: 2 · 2013: 5 · 2012: 1
- FWCI
- 7.28
- Type
- journal article
- Language
- en
- Open access
- green
- dspace.lboro.ac.uk
- Licence
- cc-by-nc-nd
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Loughborough University Institutional Repository (Loughborough University) (submittedVersion, cc-by-nc-nd)
- Funders
- British Heart Foundation (RG/10/005/28296)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- psychological distress, socioeconomic status, all-cause mortality, occupational class, General Health Questionnaire, mortality risk factors, Health Survey for England, stratified analysis
- MeSH terms
- Adult, Aged, Aged, 80 and over, England, Female, Health Surveys, Humans, Male, Middle Aged, Mortality, Surveys and Questionnaires, Random Allocation, Risk Factors, Social Class, Stress, Psychological, Proportional Hazards Models
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