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

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Russ, T. C., Stamatakis, E., Hamer, M., Starr, J. M., Kivimaki, M., Batty, G. D.·2012·BMJ

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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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Fig 1 Flow chart of participants from initial pooled sample to analytic sample showing subsequent mortalityCC BY-NC · PubMed Central

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 deathCC BY-NC · PubMed Central

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 distressCC BY-NC · PubMed Central

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Authors: Russ, T. C., Stamatakis, E., Hamer, M., Starr, J. M., Kivimaki, M., & Batty, G. D.
Affiliations: National Health Service Scotland (GB)
University College London (GB)
Corresponding author: Russ, T. C.
ORCID: Russ, T. C.
Stamatakis, E.
Hamer, M.
Starr, J. M.
Batty, G. D.
Venue: BMJ
Publisher: BMJ
Published: 2012-07-31
Volume: 345
Issue: jul31 4
Pages: e4933-e4933
ISSN: 1756-1833 (ISSN-L)
DOI: 10.1136/bmj.e4933
PMC: PMC3409083
OpenAlex: W2126872292
Cited by: 637
References: 56
Citations by year: 2026: 20 · 2025: 26 · 2024: 29 · 2023: 90 · 2022: 46 · 2021: 44 · 2020: 60 · 2019: 47 · 2018: 45 · 2017: 53 · 2016: 49 · 2015: 32 · 2014: 40 · 2013: 44 · 2012: 10
FWCI: 6.63
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
Locations: BMJ (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Loughborough University Institutional Repository (Loughborough University) (submittedVersion, cc-by)
UCL Discovery (University College London) (submittedVersion)
Loughborough University Research Repository (Loughborough University) (submittedVersion, cc-by)
HighWire Press Open Archive (submittedVersion)
Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
Funders: Wellcome Trust
Scottish Government
National Institute for Health and Care Research (R01AG034454)
British Heart Foundation (RG/10/005/28296, RG/07/008/23674)
University of Edinburgh (G0700704/84698)
Academy of Finland (R01 AG034454)
Centre for Cognitive Ageing and Cognitive Epidemiology
National Institutes of Health
Directorate for Biological Sciences
Medical Research Council (R01AG034454)
Engineering and Physical Sciences Research Council
Biotechnology and Biological Sciences Research Council
Economic and Social Research Council (R01AG034454, R01HL036310)
National Institute on Aging (R01AG034454)
National Heart, Lung, and Blood Institute (R01HL036310)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Social Sciences › Health › Health disparities and outcomes
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: psychological distress, mortality, cause-specific mortality, cardiovascular mortality, cancer mortality, external causes of death, dose-response relationship, General Health Questionnaire, socioeconomic factors, comorbidities
MeSH terms: Adult, Aged, Aged, 80 and over, Cause of Death, England, Female, Health Surveys, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, Stress, Psychological

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

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