The Association Between Perceived Stress and Mortality Among People With Multimorbidity: A Prospective Population-Based Cohort Study

Prior, Anders; Fenger-Grøn, Morten; Larsen, Karen Kjær; Larsen, Finn Breinholt; Robinson, Kirstine Magtengaard; Nielsen, Marie Germund; Christensen, Kaj Sparle; Mercer, Stewart W.; Vestergaard, Mogens

doi:10.1093/aje/kwv324

Cited by 202Chronic Disease Management StrategiesHealth, psychology, and well-beingCardiac Health and Mental Health

The Association Between Perceived Stress and Mortality Among People With Multimorbidity: A Prospective Population-Based Cohort Study

Prior, Anders, Fenger-Grøn, Morten, Larsen, Karen Kjær, Larsen, Finn Breinholt, Robinson, Kirstine Magtengaard, Nielsen, Marie Germund, Christensen, Kaj Sparle, Mercer, Stewart W. +1 more·2016·American Journal of Epidemiology

DOI 10.1093/aje/kwv324

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Abstract

Multimorbidity is common and is associated with poor mental health and high mortality. Nevertheless, no studies have evaluated whether mental health may affect the survival of people with multimorbidity. We investigated the association between perceived stress and mortality in people with multimorbidity by following a population-based cohort of 118,410 participants from the Danish National Health Survey 2010 for up to 4 years. Information on perceived stress and lifestyle was obtained from the survey. We assessed multimorbidity using nationwide register data on 39 conditions and identified 4,229 deaths for the 453,648 person-years at risk. Mortality rates rose with increasing levels of stress in a dose-response relationship (P-trend < 0.0001), independently of multimorbidity status. Mortality hazard ratios (highest stress quintile vs. lowest) were 1.51 (95% confidence interval (CI): 1.25, 1.84) among persons without multimorbidity, 1.39 (95% CI: 1.18, 1.64) among those with 2 or 3 conditions, and 1.43 (95% CI: 1.18, 1.73) among those with 4 or more conditions, when adjusted for disease severities, lifestyle, and socioeconomic status. The numbers of excess deaths associated with high stress were 69 among persons without multimorbidity, 128 among those with 2 or 3 conditions, and 255 among those with 4 or more conditions. Our findings suggested that perceived stress contributes significantly to higher mortality rates in a dose-response pattern, and more stress-associated deaths occurred in people with multimorbidity.

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Stress is an independent risk factor for illness and even mortality.
“stress is an independent risk factor for illness and even mortality [5–7].”
From A pilot randomised trial comparing a mindfulness-based stress reduction course, a locally-developed stress reduction intervention and a waiting list control group in a real-life municipal health care setting (2020) · cites this paper as [7]
A Danish population-based study has shown a dose-response relationship between perceived stress measured by the Perceived Stress Scale and mortality within a four-year period.
“A Danish population-based study has shown a dose-response relationship between perceived stress measured by the Perceived Stress Scale [8] and mortality within a four-year period [7].”
From A pilot randomised trial comparing a mindfulness-based stress reduction course, a locally-developed stress reduction intervention and a waiting list control group in a real-life municipal health care setting (2020) · cites this paper as [7]
The mean PSS score was higher than 18, which has been associated with higher mortality within a four-year period.
“The mean PSS score was higher than 18, which has been associated with higher mortality within a four-year period [7].”
From A pilot randomised trial comparing a mindfulness-based stress reduction course, a locally-developed stress reduction intervention and a waiting list control group in a real-life municipal health care setting (2020) · cites this paper as [7]

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Contacts in general practice during the COVID-19 pandemic: a register-based study
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Prevalence and correlates of diabetes distress, perceived stress and depressive symptoms among adults with early‐onset Type 2 diabetes: cross‐sectional survey results from the Danish DD2 study
Bo, A., Pouwer, F., Juul, L., Nicolaisen, S. K., & Maindal, H. T. (2019) · Diabetic Medicine · doi:10.1111/dme.14087 · Cited by 40 · see citing works
Trauma, adversity, and biological aging: behavioral mechanisms relevant to treatment and theory
Bourassa, K. J., & Sbarra, D. A. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-03004-9 · Cited by 40 · see citing works
Socioeconomic determinants and disparities in sarcoidosis
Sharp, M., Eakin, M. N., & Drent, M. (2020) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000000704 · Cited by 39 · see citing works
Adherence to the Mediterranean diet in Cyprus and its relationship to multi-morbidity: an epidemiological study
Kyprianidou, M., Panagiotakos, D. B., Faka, A., Kambanaros, M., Makris, K. C., & Christophi, C. A. (2020) · Public Health Nutrition · doi:10.1017/s1368980020004267 · Cited by 38 · see citing works
The effectiveness of mindfulness-based stress reduction for school teachers: a cluster-randomized controlled trial
Bonde, E. H., Fjorback, L. O., Frydenberg, M., & Juul, L. (2022) · European Journal of Public Health · doi:10.1093/eurpub/ckab223 · Cited by 36 · see citing works
Dementia and the risk of short-term readmission and mortality after a pneumonia admission
Graversen, S. B., Pedersen, H. S., Sandbaek, A., Foss, C. H., Palmer, V. J., & Ribe, A. R. (2021) · PLOS ONE · doi:10.1371/journal.pone.0246153 · Cited by 34 · see citing works
Purpose in life and stress: An individual-participant meta-analysis of 16 samples
Sutin, A., Luchetti, M., Stephan, Y., Sesker, A. A., & Terracciano, A. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.149 · Cited by 33 · see citing works
Childhood trauma, perceived stress, and hair cortisol in adults with and without cardiovascular disease
Bossé, S., Stalder, T., & D'Antono, B. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000569 · Cited by 33 · see citing works
The sex-dependent response to psychosocial stress and ischaemic heart disease
Helman, T. J., Headrick, J. P., Stapelberg, N. J. C., & Braidy, N. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1072042 · Cited by 34 · see citing works
Mental Disorders in Danish Hospital Registers: A Review of Content and Possibilities for Epidemiological Research
Plana‐Ripoll, O., Liu, X., Köhler‐Forsberg, O., Sørensen, H. T., & Momen, N. C. (2025) · Clinical Epidemiology · doi:10.2147/clep.s509147 · Cited by 30 · see citing works
Effect of a Compassion Cultivation Training Program for Caregivers of People With Mental Illness in Denmark
Hansen, N. H., Juul, L., Pallesen, K. J., & Fjorback, L. O. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.1020 · Cited by 30 · see citing works
Improving Health Care for Patients with Multimorbidity: A Mixed-Methods Study to Explore the Feasibility and Process of Aligning Scheduled Outpatient Appointments through Collaboration between Medical Specialties
Bell, C., Appel, C., Frølich, A., Prior, A., & Vedsted, P. (2022) · International Journal of Integrated Care · doi:10.5334/ijic.6013 · Cited by 30 · see citing works
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A pilot randomised trial comparing a mindfulness-based stress reduction course, a locally-developed stress reduction intervention and a waiting list control group in a real-life municipal health care setting
Juul, L., Pallesen, K. J., Bjerggaard, M., Nielsen, C., & Fjorback, L. O. (2020) · BMC Public Health · doi:10.1186/s12889-020-08470-6 · Cited by 29 · see citing works
The Effects of a Mindfulness Program on Mental Health in Students at an Undergraduate Program for Teacher Education: A Randomized Controlled Trial in Real-Life
Juul, L., Brorsen, E., Gøtzsche, K., Nielsen, B. L., & Fjorback, L. O. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.722771 · Cited by 28 · see citing works
Associations between physical diseases and subsequent mental disorders: a longitudinal study in a population‐based cohort
Momen, N. C., Østergaard, S. D., Heide‐Jørgensen, U., Sørensen, H. T., McGrath, J. J., & Plana‐Ripoll, O. (2024) · World Psychiatry · doi:10.1002/wps.21242 · Cited by 27 · see citing works
Frequency of health care utilization in the year prior to completed suicide: A Danish nationwide matched comparative study
Pedersen, H. S., Fenger‐Grøn, M., Bech, B. H., Erlangsen, A., & Vestergaard, M. (2019) · PLoS ONE · doi:10.1371/journal.pone.0214605 · Cited by 27 · see citing works
Self-citation
Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure
Endrighi, R., Dimond, A. J., Waters, A. J., Dimond, C. C., Harris, K. M., Gottlieb, S. S., & Krantz, D. S. (2019) · Psychology and Health · doi:10.1080/08870446.2019.1609676 · Cited by 27 · see citing works
Decision-making process in the pre-dialysis CKD patients: do anxiety, stress and depression matter?
Bezerra, C. I. L., da Silva, B. C., & Elias, R. M. (2018) · BMC Nephrology · doi:10.1186/s12882-018-0896-3 · Cited by 27 · see citing works
Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder
Østergaard, S. D., Momen, N. C., Heide‐Jørgensen, U., & Plana‐Ripoll, O. (2024) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.2561 · Cited by 26 · see citing works
Area-based socioeconomic disparities in mortality due to unintentional injury and youth suicide in British Columbia, 2009–2013
Zandy, M., Zhang, L. R., Kao, D. Y.-T., Rajabali, F., Turcotte, K., Zheng, A., Oakey, M., Smolina, K., Pike, I., & Rasali, D. P. (2019) · Health Promotion and Chronic Disease Prevention in Canada · doi:10.24095/hpcdp.39.2.01 · Cited by 26 · see citing works
Attendance of routine childcare visits in primary care for children of mothers with depression: a nationwide population-based cohort study
Lyngsøe, B. K., Vestergaard, C. H., Rytter, D., Vestergaard, M., Munk‐Olsen, T., & Bech, B. H. (2018) · British Journal of General Practice · doi:10.3399/bjgp18x694565 · Cited by 25 · see citing works
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Psychological stress in long-term testicular cancer survivors: a Danish nationwide cohort study
Kreiberg, M., Bandak, M., Lauritsen, J., Andersen, K. K., Skøtt, J. W., Johansen, C., Agerbæk, M., Holm, N. V., Lau, C. J., & Daugaard, G. (2019) · Journal of Cancer Survivorship · doi:10.1007/s11764-019-00835-0 · Cited by 25 · see citing works
Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care–sensitive Conditions
Prior, A., Vestergaard, M., Davydow, D. S., Larsen, K. K., Ribe, A. R., & Fenger‐Grøn, M. (2016) · Medical Care · doi:10.1097/mlr.0000000000000632 · Cited by 24 · see citing works
Self-citation
Use of general practice before and after mild traumatic brain injury: a nationwide population-based cohort study in Denmark
Galili, S. F., Bech, B. H., Vestergaard, C. H., Fenger‐Grøn, M., Christensen, J., Vestergaard, M., & Ahrensberg, J. M. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017735 · Cited by 24 · see citing works
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Prevalence of persons contacting general practice for psychological stress in Denmark
Lykkegaard, J., Rosendal, M., Brask, K., Brandt, L. P. A., & Prior, A. (2018) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2018.1499494 · Cited by 24 · see citing works
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The relative contributions of behavioral, biological, and psychological risk factors in the association between psychosocial stress and all-cause mortality among middle- and older-aged adults in the USA
Rodgers, J., Cuevas, A. G., Williams, D. R., Kawachi, I. I., & Subramanian, S. V. (2021) · GeroScience · doi:10.1007/s11357-020-00319-5 · Cited by 23 · see citing works
Multimorbidity measures from health administrative data using ICD system codes: A systematic review
Simard, M., Rahme, E., Calfat, A. C., & Sirois, C. (2021) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.5368 · Cited by 23 · see citing works
Representativeness of survey participants in relation to mental disorders: a linkage between national registers and a population-representative survey
Momen, N. C., Lasgaard, M., Weye, N., Edwards, J., McGrath, J. J., & Plana‐Ripoll, O. (2022) · International Journal for Population Data Science · doi:10.23889/ijpds.v7i4.1759 · Cited by 23 · see citing works
Effectiveness of Mindfulness-Based Stress Reduction in a Self-Selecting and Self-Paying Community Setting
Juul, L., Pallesen, K. J., Piet, J., Parsons, C., & Fjorback, L. O. (2018) · Mindfulness · doi:10.1007/s12671-017-0873-0 · Cited by 22 · see citing works
“We pre-defined a cut-point of ≥18 because a recent Danish population-based study has shown that this cut-point is associated with an increased mortality risk compared to a perceived stress level of below 7 (Prior et al. 2016).”
BackgroundMethodInfluential
Income inequality and deaths of despair risk in Canada, identifying possible mechanisms
Loverock, A., Benny, C., Smith, B. T., Siddiqi, A., & Pabayo, R. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.116623 · Cited by 22 · see citing works
Causal effect of shifting from precarious to standard employment on all-cause mortality in Sweden: an emulation of a target trial
Matilla-Santander, N., Matthews, A. A., Gunn, V., Muntaner, C., Kreshpaj, B., Wegman, D., Sánchez-Martínez, N., Hernando-Rodriguez, J., Albin, M., Balogh, R., et al. (2023) · Journal of Epidemiology and Community Health · doi:10.1136/jech-2023-220734 · Cited by 14 · see citing works
Cohort profile: The prospective study on Chinese elderly with multimorbidity in primary care in Hong Kong
Zhang, D., Sit, R. W. S., Wong, C. K. M., Zou, D., Mercer, S. W., Johnston, M. C., & Wong, S. Y. S. (2020) · BMJ Open · doi:10.1136/bmjopen-2018-027279 · Cited by 22 · see citing works
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Bidirectional associations between treatment-resistant depression and general medical conditions
Madsen, K. B., Momen, N. C., Petersen, L. V., Plana‐Ripoll, O., Haarman, B. C. M., Drexhage, H. A., Mortensen, P. B., McGrath, J. J., & Munk‐Olsen, T. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.04.021 · Cited by 23 · see citing works
Continuity of care in general practice and patient outcomes in Denmark: a population-based cohort study
Prior, A., Rasmussen, L. A., Virgilsen, L. F., Vedsted, P., & Vestergaard, M. (2025) · The Lancet Primary Care · doi:10.1016/j.lanprc.2025.100016 · Cited by 21 · see citing works
Self-citation
Association between food insecurity and perceived stress among older adults (50+) in six low- and middle-income countries
Selvamani, Y., & Perianayagam, A. (2021) · Aging & Mental Health · doi:10.1080/13607863.2021.1985965 · Cited by 21 · see citing works
Routes to cancer diagnosis for patients with pre-existing psychiatric disorders: a nationwide register-based cohort study
Virgilsen, L. F., Vedsted, P., Falborg, A. Z., Pedersen, A. F., Prior, A., & Jensen, H. (2022) · BMC Cancer · doi:10.1186/s12885-022-09598-x · Cited by 21 · see citing works
Self-citation
The relationship between mindfulness and mental health among Chinese college students during the closed-loop management of the COVID-19 pandemic: A moderated mediation model
Yuan, J., Sun, F., Zhao, X., Liu, Z., & Liang, Q. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.02.012 · Cited by 21 · see citing works
Chronic Psychosocial Stress in Mice Is Associated With Increased Acid Sphingomyelinase Activity in Liver and Serum and With Hepatic C16:0-Ceramide Accumulation
Reichel, M., Rhein, C., Hofmann, L. M., Monti, J., Japtok, L., Langgartner, D., Füchsl, A. M., Kleuser, B., Gulbins, E., Hellerbrand, C., et al. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00496 · Cited by 20 · see citing works
Maternal depression and primary healthcare use for children: a population-based cohort study in Denmark
Lyngsøe, B. K., Rytter, D., Munk‐Olsen, T., Vestergaard, C. H., Christensen, K. S., & Bech, B. H. (2018) · British Journal of General Practice · doi:10.3399/bjgp18x700733 · Cited by 19 · see citing works
Self-citation
Analysis of mortality metrics associated with a comprehensive range of disorders in Denmark, 2000 to 2018: A population-based cohort study
Plana‐Ripoll, O., Dreier, J. W., Momen, N. C., Prior, A., Weye, N., Mortensen, P. B., Pedersen, C. B., Iburg, K. M., Christensen, M. K., Laursen, T. M., et al. (2022) · PLoS Medicine · doi:10.1371/journal.pmed.1004023 · Cited by 20 · see citing works
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The relative importance of work-related and non-work-related stressors and perceived social support on global perceived stress in a cross-sectional population-based sample
Sørensen, J. B., Lasgaard, M., Willert, M. V., & Larsen, F. B. (2021) · BMC Public Health · doi:10.1186/s12889-021-10594-2 · Cited by 19 · see citing works
Self-citation
Psychological distress, social support, and use of outpatient care among adult men and women with coronary artery disease or other non-cardiovascular chronic disease
Bouchard, V., Robitaille, A., Perreault, S., Cyr, M., Tardif, J., Busseuil, D., & D’Antono, B. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.111131 · Cited by 18 · see citing works
Mindfulness, Health, and Longevity
Dahlgaard, J., Jørgensen, M. M., van der Velden, A. M., Sumbundu, A. D., Gregersen, N., Olsen, R. K. J., & Mehlsen, M. Y. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-814253-0.00022-x · Cited by 18 · see citing works
Chronic care services and variation between Danish general practices: a nationwide cohort study
Prior, A., Vestergaard, C. H., Ribe, A. R., Sandbæk, A., Bro, F., Vedsted, P., Smith, S., Vestergaard, M., & Fenger-Grøn, M. (2021) · British Journal of General Practice · doi:10.3399/bjgp.2021.0419 · Cited by 17 · see citing works
Self-citation
Trajectories in Outpatient Care for People with Multimorbidity: A Population-Based Register Study in Denmark
Bell, C., Prior, A., Frølich, A., Appel, C., & Vedsted, P. (2022) · Clinical Epidemiology · doi:10.2147/clep.s363654 · Cited by 17 · see citing works
Self-citation
Schizophrenia and attendance in primary healthcare: a population-based matched cohort study
Nørgaard, H. C. B., Pedersen, H. S., Fenger‐Grøn, M., Vestergaard, M., Nordentoft, M., Laursen, T. M., & Mors, O. N. (2019) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2019.1639927 · Cited by 17 · see citing works
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Labour market participation and retirement after stroke in Denmark: registry based cohort study
Skajaa, N., Adelborg, K., Horváth–Puhó, E., Rothman, K. J., Henderson, V. W., Thygesen, L. C., & Sørensen, H. T. (2023) · BMJ · doi:10.1136/bmj-2022-072308 · Cited by 16 · see citing works
The dimensionality of the Perceived Stress Scale: The presence of opposing items is a source of measurement error
Pedersen, H. S., Christensen, K. S., Prior, A., & Christensen, K. B. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.109 · Cited by 19 · see citing works
Self-citation
The development of multimorbidity during 16 years after diagnosis of type 2 diabetes
Pouplier, S. S., Olsen, M. Å., Willadsen, T. G., Sandholdt, H., Siersma, V., Andersen, C. L., & Olivarius, N. D. F. (2018) · Journal of Comorbidity · doi:10.1177/2235042x18801658 · Cited by 16 · see citing works
Factors Associated With 30-Day Rehospitalization and Mortality in Older Patients After a Pneumonia Admission
Graversen, S. B., Pedersen, H. S., Sandbæk, A., Foss, C. H., & Ribe, A. R. (2020) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.08.025 · Cited by 16 · see citing works
Agreement between self-reported morbidity and pharmacy claims data for prescribed medications in an older community based population
Mannion, C., Hughes, J. E., Moriarty, F., Bennett, K., & Cahir, C. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01684-8 · Cited by 14 · see citing works
Associations of perceived stress, depressive symptoms, and caregiving with inflammation: a longitudinal study
Elayoubi, J., Haley, W. E., Roth, D. L., Cushman, M., Sheehan, O. C., Howard, V. J., Hladek, M. D., & Hülür, G. (2022) · International Psychogeriatrics · doi:10.1017/s1041610222000370 · Cited by 16 · see citing works
Pre-retirement Employees Experience Lasting Improvements in Resilience and Well-Being After Mindfulness-Based Stress Reduction
Diachenko, M., Smith, K. K., Fjorback, L. O., Hansen, N. V., Linkenkaer‐Hansen, K., & Pallesen, K. J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.699088 · Cited by 16 · see citing works
Potentially inappropriate medications (PIMs): frequency and extent of GP-related variation in PIMs: a register-based cohort study
Ribe, A. R., Christensen, L. D., Vestergaard, C. H., Prior, A., Brynningsen, P. K., Bro, F., Sandbæk, A., Vedsted, P., Witte, D. R., & Fenger‐Grøn, M. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-046756 · Cited by 15 · see citing works
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Does perceived stress increase the risk of atrial fibrillation? A population-based cohort study in Denmark
Graff, S., Prior, A., Fenger‐Grøn, M., Christensen, B. M., Glümer, C., Larsen, F. B., & Vestergaard, M. (2017) · American Heart Journal · doi:10.1016/j.ahj.2017.03.002 · Cited by 15 · see citing works
Self-citation
Financial difficulties and patient-reported outcomes among patients with advanced heart failure
Malhotra, C., Bundoc, F. G., Ang, F. J. L., Özdemir, S., Teo, I., Sim, D., Jaufeerally, F. R., Aung, T., & Finkelstein, E. A. (2021) · Quality of Life Research · doi:10.1007/s11136-020-02736-7 · Cited by 14 · see citing works
Association of lifestyle and sociodemographic factors on multimorbidity: a cross-sectional study in Portugal
Páscoa, R., Teixeira, A., Monteiro, H. J., Prazeres, F., & Martins, C. (2022) · BMC Public Health · doi:10.1186/s12889-022-14640-5 · Cited by 14 · see citing works
The contribution of general medical conditions to the non-fatal burden of mental disorders: register-based cohort study in Denmark
Weye, N., Momen, N. C., Whiteford, H., Christensen, M. K., Iburg, K. M., Santomauro, D. F., Agerbo, E., Mortensen, P. B., Pedersen, C. B., McGrath, J. J., et al. (2022) · BJPsych Open · doi:10.1192/bjo.2022.583 · Cited by 13 · see citing works
Use of Video in Telephone Triage in Out-of-Hours Primary Care: Register-Based Study
Nebsbjerg, M. A., Vestergaard, C. H., Bomholt, K. B., Christensen, M. B., & Huibers, L. (2024) · JMIR Medical Informatics · doi:10.2196/47039 · Cited by 12 · see citing works
Does positive affect mediate the association of multimorbidity on depressive symptoms?
Demirer, I., Kühhirt, M., Karbach, U., & Pfaff, H. (2021) · Aging & Mental Health · doi:10.1080/13607863.2020.1870209 · Cited by 12 · see citing works
Interstitial Lung Disease and Sarcoidosis
Sharp, M., Mustafa, A., Farah, N., & Bonham, C. A. (2023) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2023.06.003 · Cited by 12 · see citing works
Mental health and sociodemographic characteristics among Icelanders, data from a cross-sectional study in Iceland
Sigurdardottir, S., Aspelund, T., Guðmundsdóttir, D. G., Fjorback, L. O., Hrafnkelsson, H., Hansdóttir, I., & Juul, L. (2023) · BMC Psychiatry · doi:10.1186/s12888-022-04504-y · Cited by 11 · see citing works
Medical conditions and the risk of subsequent major depressive disorder: a nationwide, register-based, retrospective cohort study
Sigvardsen, P. E., Fosbøl, E. L., Jørgensen, A., Torp-Pedersen, C., Køber, L., & Kofoed, K. F. (2025) · The Lancet Public Health · doi:10.1016/s2468-2667(25)00073-8 · Cited by 11 · see citing works
Antipsychotics and Risks of Cardiovascular and Cerebrovascular Diseases and Mortality in Dwelling Community Older Adults
Perreault, S., Boivin‐Proulx, L., Brouillette, J., Jarry, S., & Dorais, M. (2024) · Pharmaceuticals · doi:10.3390/ph17020178 · Cited by 11 · see citing works
SmileApp: The Design and Evaluation of an mHealth App for Stress Reduction Through Artificial Intelligence and Persuasive Technology
Orji, J., Chan, G., Ndulue, C., & Orji, R. (2024) · Lecture notes in computer science · doi:10.1007/978-3-031-58226-4_18 · Cited by 10 · see citing works
The association between sleep, mental health, and health behaviours: a Danish population-based cross-sectional study
Damgaard, A. J., Sørensen, J. B., Jensen, M. M., & Pedersen, P. (2024) · Scandinavian Journal of Public Health · doi:10.1177/14034948241262366 · Cited by 10 · see citing works
Development over time in point-of-care test use in Danish daytime and out-of-hours general practice: a register-based study
Kjær, N. K., Hansen, M. P., Pedersen, H. S., Christensen, M. B., & Huibers, L. (2023) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2023.2187667 · Cited by 10 · see citing works
Dietary, physical exercises and mental stress in a Chinese population: a cross-sectional study
Li, X., Tian, D., Qin, P., Guo, W., Lü, J., Zhu, W., Zhang, Q., & Wang, J. (2021) · BMC Public Health · doi:10.1186/s12889-021-11189-7 · Cited by 10 · see citing works
COVID-19 Pandemic and Lockdown: Associations With Personality and Stress Components
Smrdu, M., Kuder, A., Turk, E., Čelik, T., Šet, J., & Kralj‐Fišer, S. (2021) · Psychological Reports · doi:10.1177/00332941211043451 · Cited by 9 · see citing works
Psychosocial stress and ovarian function in adolescent and young adult cancer survivors
Kim, J., Whitcomb, B. W., Kwan, B., Zava, D. T., Sluss, P. M., Dietz, A. C., Shliakhtsitsava, K., Romero, S. A. D., Natarajan, L., & Su, H.-C. I. (2020) · Human Reproduction · doi:10.1093/humrep/deaa313 · Cited by 9 · see citing works
Health and Well‐Being in Older Adults With a Surgically Closed or an Unrepaired Ventricular Septal Defect
Maagaard, M., Eckerström, F., Schram, A. L., Jensen, H. A. R., & Hjortdal, V. E. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.028538 · Cited by 9 · see citing works
Maternal depression and childhood injury risk: A population‐based cohort study in Denmark
Lyngsøe, B. K., Munk‐Olsen, T., Vestergaard, C. H., Rytter, D., Christensen, K. S., & Bech, B. H. (2021) · Brain and Behavior · doi:10.1002/brb3.2029 · Cited by 9 · see citing works
Self-citation
Stress and Allostatic Load Among Latina/os: Evidence from the Hispanic Community Health Study/Study of Latina/os
Niño, M., & Chavez, Y. Z. (2021) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01175-x · Cited by 8 · see citing works
General practitioners’ management of patients with psychological stress: audit results from Denmark
Lykkegaard, J., Prior, A., & Rosendal, M. (2020) · BMC Family Practice · doi:10.1186/s12875-020-01137-6 · Cited by 8 · see citing works
Self-citation
Coocorrência de fatores de risco à saúde em universitários de uma instituição de ensino superior brasileira
de Sousa, T. F., Loch, M. R., Lima, A. J. D. O., Franco, D. C., & Barbosa, A. R. (2021) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232021262.07062019 · Cited by 8 · see citing works
High Social Coping Self-Efficacy Associated With Lower Sweat Interleukin-6 in Older Adults With Chronic Illness
Hladek, M. D., Gill, J., Lai, C., Bandeen‐Roche, K., Xue, Q., Allen, J. K., Leyden, C., Kanefsky, R. Z., & Szanton, S. L. (2021) · Journal of Applied Gerontology · doi:10.1177/07334648211006518 · Cited by 8 · see citing works
Association of objective and subjective far vision impairment with perceived stress among older adults in six low- and middle-income countries
Jacob, L., Kostev, K., Smith, L., Sánchez, G. F. L., Pardhan, S., Oh, H. Y., Shin, J. I., Abduljabbar, A. S., Haro, J. M., & Koyanagi, A. (2021) · Eye · doi:10.1038/s41433-021-01634-7 · Cited by 8 · see citing works

Psychological stress and multimorbidity in general practice
Prior, A. (2017)
Self-citation
Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care–sensitive Conditions
Prior, A., Vestergaard, M., Davydow, D. S., Larsen, K. K., Ribe, A. R., & Fenger‐Grøn, M. (2016) · Medical Care · doi:10.1097/mlr.0000000000000632 · Cited by 24 · see citing works
Self-citation
Perceived stress and mortality in a Taiwanese older adult population
Vasunilashorn, S. M., Glei, D. A., Weinstein, M., & Goldman, N. (2013) · Stress · doi:10.3109/10253890.2013.823943 · Cited by 46 · see citing works
Multimorbidity and Mental Health‐Related Quality of Life and Risk of Completed Suicide
Wei, M. Y., & Mukamal, K. J. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15678 · Cited by 66 · see citing works
Association of perceived stress with risks of subsequent illness and death among elderly according to Costa Rican Longevity and Healthy Aging Study (CRELES)
Méndez-Chacón, E. (2025) · Aging & Mental Health · doi:10.1080/13607863.2025.2558887 · Cited by 2 · see citing works

Authors: Prior, A., Fenger-Grøn, M., Larsen, K. K., Larsen, F. B., Robinson, K. M., Nielsen, M. G., Christensen, K. S., Mercer, S. W., & Vestergaard, M.
Affiliations: Aarhus University (DK)
Corresponding author: Prior, Anders
ORCID: Prior, Anders
Larsen, Finn Breinholt
Nielsen, Marie Germund
Christensen, Kaj Sparle
Mercer, Stewart W.
Vestergaard, Mogens
Venue: American Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2016-07-11
Volume: 184
Issue: 3
Pages: 199-210
ISSN: 0002-9262 (ISSN-L)
1476-6256
DOI: 10.1093/aje/kwv324
OpenAlex: W2471218679
Cited by: 202
References: 54
Citations by year: 2026: 17 · 2025: 24 · 2024: 28 · 2023: 27 · 2022: 23 · 2021: 31 · 2020: 19 · 2019: 11 · 2018: 13 · 2017: 7 · 2016: 1 · 2015: 1
FWCI: 9.99
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Epidemiology (publishedVersion)
PubMed (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
HighWire Press Open Archive (submittedVersion)
Scopus (Elsevier) (submittedVersion)
Funders: Aarhus Universitet
University of Glasgow
Lundbeckfonden (R155-2012-11280)
Region Hovedstaden
Syddansk Universitet
Region Sjælland
Region Midtjylland
H. Lundbeck A/S
Topics: Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords: perceived stress, multimorbidity, mortality, mental health, dose-response relationship, excess mortality, chronic disease burden, socioeconomic status, lifestyle factors
MeSH terms: Multiple Chronic Conditions, Adult, Aged, Alcohol Drinking, Cause of Death, Denmark, Feeding Behavior, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Perception, Registries, Smoking, Stress, Psychological, Health Behavior, Incidence, Prevalence, Proportional Hazards Models, Sex Distribution, Sedentary Behavior

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The Association Between Perceived Stress and Mortality Among People With Multimorbidity: A Prospective Population-Based Cohort Study

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