Sickness and Early Death: Outcomes of Even Low-Level Mental Disorders?

Posted on August 23, 2012 by


Do you remember how, many, many years ago, in a era before political correctness, we used to refer to people we thought were totally ‘off’ as ‘head cases’? Frankly I thought that term had gone out with the “Dukes of Hazard,” but I was doing my dose of mental health research, keeping up in the field, I came across it again–and in the most unpleasant and serious of contexts.

In a post entitled “25 Years Early: The Possible Death Decree for the Seriously Mentally Ill,” I addressed how serious mental illness (SMI) has been implicated in increased sickness and early mortality for those who suffer from it.

But much of what we have known about increased risk of mortality has dealt with those with major depressive disorder, schizophrenia, full-blown bipolar disorder.

But what should I find as I’m perusing my Mental Elf app (you can see a few of my favorite mental health apps here), where I can find summaries of the latest in psychological research, but that even those with sub-threshold disorders can fall sick and die earlier?

The original paper is in the British Journal of Medicine, with the rather ungainly title of  “Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies,” and the researchers conclude that disease and mortality can increase from almost any brush with psychological distress, and, they do so in direct proportion to the degree distress. But they don’t mean mental illness, not at all. They wrote, there is a

“dose-response association between psychological distress and mortality from all causes, cardiovascular disease, and external causes across the full range of distress, even in people who would not usually come to the attention of mental health services.

To reach this determination, researchers led by Tom C Russ, Alzheimer Scotland clinical research fellow, surveyed 68,222 adults in England, aged 35 or over, and free of heart disease and cancer at baseline. They divided them into 10 large prospective cohort studies, and set off to visit and interview them. measuring psychological distress using the 12-question General HealthQuestionnaire score. The GHQ-12 assesses symptoms of depression anxiety, and social and lack of confidence issues. A score of  four or above leads to people being labeled as (I couldn’t make this up) “cases,” while those with three or below are “non-cases.” [Who knew you could still get away with the term?]

Sure enough, the “cases” were sicker and died earlier. Even the “non-cases” couldn’t escape:

“Even the subclinically symptomatic group (score 1-3) had a 20% increased risk of mortality after adjusting for age and sex.”

The graphs of the data paint the picture–it is a dose-related relationship. The mean follow-up time was 8.2 years, and the more psychological distress, the more likely a subject was to die within the time frame of the study.

(Tom C Russ, et al 2012)

The second graph, that of cardiovascular disease, showed a particular increased risk in connection with psychological distress, even with low levels of distress (those famous “non-cases”).”[S]ubclinically symptomatic patients were at a 29% increased risk of cardiovascular disease death.”

From the third graph you can see that low levels of distress didn’t correlate with cancer mortality in the same way as they did in cardiovascular death, but high levels of GHQ-12 scores (6-12, the real “cases, I suppose) were correlated with a 41% increased risk of cancer death.

Finally, in the fourth graph, you can see tha death “from external causes” was also correlated with psychological distress. “subclinically symptomatic patients were” had a 29% increased risk of death from external causes.

Astoundingly, these correlations held even after adjustments were made for sex, age, social class, body mass index, blood pressure, physical activity, alcohol consumption–and diabetes.

The study clearly indicates that does-related association between early mortality psychological distress, even for those who would never have been identified as having ‘issues,’ as we call it nowadays.

It was depressing even to read the research paper, worrying me that maybe doing so might increase my chances of early mortality. It’s the type of thing you wish there was something you could doabout it, instead of just read.

For it certainly is rather a disheartening study, isn’t it?

And not just because I found out that I–and a number of my loved ones–might very likely qualify a “cases.”