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The Association Between Perceived Stress and Mortality Among People With Multimorbidity: A Prospective Population-Based Cohort Study
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 [5–7].”
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“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].”
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“The mean PSS score was higher than 18, which has been associated with higher mortality within a four-year period [7].”
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Metadata
- 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
- 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
- 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
- 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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