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Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies
Open accessAbstract
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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“increase susceptibility to or worse outcomes from a wide range of physical illnesses [347–351]”
From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [347]
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“Diagnosed psychiatric disorders, in turn, have been associated with higher mortality risk, including increased rates of cancer deaths.This is due to the causal relationship between stress and telomere attrition (cellular ageing) [4,11].”
From Climate Distress: A Review of Current Psychological Research and Practice (2023) · cites this paper as [11]
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“Psychological distress increases morbidity from a host of conditions and increases risk for premature mortality in a dose–response relationship.2 3”
From Novel ACT-based eHealth psychoeducational intervention for students with mental distress: A study protocol for a mixed-methodology pilot trial (2019) · cites this paper as [3]
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Metadata
- 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.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-07-31
- Volume
- 345
- Issue
- jul31 4
- Pages
- e4933-e4933
- ISSN
- 1756-1833 (ISSN-L)
- 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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