Cited by 280Cardiac Health and Mental HealthMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Levels of anxiety and depression as predictors of mortality: the HUNT study

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Mykletun, Arnstein, Bjerkeset, Ottar, øverland, Simon, Prince, Martin, Dewey, Michael, Stewart, Robert·2009·British Journal of Psychiatry

DOI 10.1192/bjp.bp.108.054866

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Abstract

BACKGROUND: Depression is reported to be associated with increased mortality, although underlying mechanisms are uncertain. Associations between anxiety and mortality are also uncertain. AIMS: To investigate associations between individual and combined anxiety/depression symptom loads (using the Hospital Anxiety and Depression Scale (HADS)) and mortality over a 3-6 year period. METHOD: We utilised a unique link between a large population survey (HUNT-2, n = 61 349) and a comprehensive mortality database. RESULTS: Case-level depression was associated with increased mortality (hazard ratio (HR) = 1.52, 95% CI 1.35-1.72) comparable with that of smoking (HR = 1.59, 95% CI 1.44-1.75), and which was only partly explained by somatic symptoms/conditions. Anxiety comorbid with depression lowered mortality compared with depression alone (anxiety depression interaction P = 0.017). The association between anxiety symptom load and mortality was U-shaped. CONCLUSIONS: Depression as a risk factor for mortality was comparable in strength to smoking. Comorbid anxiety reduced mortality compared with depression alone. The relationship between anxiety symptoms and mortality was more complex with a U-shape and highest mortality in those with the lowest anxiety symptom loads.

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Authors: Mykletun, A., Bjerkeset, O., øverland, S., Prince, M., Dewey, M., & Stewart, R.
Affiliations: Norwegian Institute of Public Health (NO)
Norwegian University of Science and Technology (NO)
University of Bergen (NO)
King's College London (GB)
Corresponding author: Mykletun, Arnstein
ORCID: Mykletun, Arnstein
Bjerkeset, Ottar
øverland, Simon
Prince, Martin
Dewey, Michael
Stewart, Robert
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2009-08
Volume: 195
Issue: 2
Pages: 118-125
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.bp.108.054866
OpenAlex: W2147161932
Cited by: 279
References: 43
Citations by year: 2026: 1 · 2025: 2 · 2024: 3 · 2023: 13 · 2022: 14 · 2021: 22 · 2020: 19 · 2019: 14 · 2018: 15 · 2017: 12 · 2016: 20 · 2015: 11 · 2014: 22 · 2013: 35 · 2012: 17
FWCI: 15.52
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified, 3076 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Funders: Norges Teknisk-Naturvitenskapelige Universitet
National Institute for Health and Care Research
King's College London
Norges Forskningsråd
Norwegian Institute of Public Health
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: depression, anxiety, mortality, comorbid depression and anxiety, Hospital Anxiety and Depression Scale, smoking, somatic symptoms, U-shaped relationship, HUNT study, risk factors
MeSH terms: Adult, Aged, Anxiety Disorders, Cause of Death, Depressive Disorder, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Norway, Comorbidity, Confounding Factors, Epidemiologic, Young Adult

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Levels of anxiety and depression as predictors of mortality: the HUNT study

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