Psychological distress – mortality
A study published in the 2012 July issue of the British Medical Journal is probably the largest so far to show that a dose-response association exists between psychological distress and major causes of mortality across the full range of distress.
In addition, an increasing body of evidence indicates an association between symptoms of depression and anxiety (often referred to as psychological distress) and mortality from various major causes, but mostly cardiovascular disease and potentially all cancers.
In the British Medical Journal study, Tom Russ and colleagues from the University of Edinburgh and University College London, UK analyzed data from over 68,000 adults aged 35 years and over who took part in the Health Survey for England from 1994 to 2004.
The study is the first to use an individual participant meta-analysis methodology of 10 large prospective cohort studies to examine the association between a psychological variable and mortality. Psychological distress was measured using the 12 item version of the General Health Questionnaire (GHQ-12), a widely used measure of distress in population studies.
The authors found a significant association, across the full range of severity, between psychological distress and all cause mortality, and this association remained after taking into account other factors such as weight, exercise, smoking, alcohol consumption and diabetes.
Even sub-clinically symptomatic patients (GHQ-12 scores 1-3) were at a 29% increased risk of cardiovascular disease death or death from external causes. Cancer death was not associated with low levels of psychological distress; however, psychological distress in highly symptomatic patients (GHQ-12 scores 6-12) was associated with a 41% increased risk of cancer death.
In a press release, Dr Tom Russ, the lead author, and Dr David Batty, the senior author, commented that “even people with low distress scores were at an increased risk of death. Currently these people—a quarter of the adult population—are unlikely to come to the attention of mental health services due to these symptoms and may not be receiving treatment”, and “If you score one, two or three on this scale you may be suffering some form of social dysfunction or loss of confidence but your GP will not diagnose you with psychological distress”.
According to the authors, this “should prompt research into whether treatment of these very common, minor symptoms can modify this increased risk of death.”
SOURCE: BMJ, 2012, 345:e4933. doi: 10.1136/bmj.e4933.
A 2020 study by Lili Yang et al. used a large US population-based cohort, 330 367 participants aged ≥18 years. The study was based on data from 1997 to 2009 US National Health Interview Survey, and psychological distress was measured using Kessler-6 scale. This study found a dose–response relationship between psychological distress and all-cause and cause-specific mortality.
A 2020 commentary by David Goldstein, published here on BrainImmune, “discusses that low efficiency of homeostatic systems (dyshomeostasis) in concert with stress system activation increases the likelihood of transitioning to acute respiratory distress syndrome (ARDS) and multi-organ failure due to induction of positive feedback loops (vicious cycles) in patients with COVID-19.
A 2021 study by Wentao Huang et al. investigated the association of psychological distress with all-cause, cardiovascular disease and cancer mortality in US adults. A total of 485,864 adults (446,288 without diabetes and 39,576 with diabetes) who participated in the National Health Interview Survey from 1997 to 2013 were included in this study. Psychological distress was measured by the Kessler 6 distress scale (K6). The study found that psychological distress was associated with higher mortality, particularly in participants with diabetes.
Another 2021 study by Hyunjung Lee et al. used the pooled 1997-2014 data from the National Health Interview Survey linked to National Death Index (n = 513,081) to examine the association of the Kessler 6-item psychological distress scale. This study found that U.S. adults with serious psychological distress had significantly higher mortality risk and lower life expectancy.
A 2022 study by Meghan Hockey et al. used data from 195, 531 adults, who participated in the National Health Interview Survey (NHIS). The study found a dose–response association between levels of psychological distress and all-cause mortality – psychological distress symptoms, of all levels, were associated with an increased risk of all-cause and cardiovascular disease -specific mortality while higher psychological distress only was associated with suicide.