Research Unit for General Practice,Department of Public Health,Aarhus University,Bartholins Allé 2, Aarhus,Denmark.
Department of Psychiatry and Behavioral Sciences,University of Washington,Box 359911,325 Ninth Ave,Seattle, WA,USA.
Psychol Med. 2018 Jul;48(9):1437-1443. doi: 10.1017/S0033291717002380. Epub 2017 Aug 30.
Mental stress is associated with higher mortality, but it remains controversial whether the association is causal or a consequence of a higher physical disease burden in those with a high mental stress load. Understanding causality is important when developing targeted interventions. We aimed to estimate the effect of mental stress on mortality by performing a 'natural' experiment using spousal bereavement as a disease-independent mental stressor.
We followed a population-based matched cohort, including all individuals in Denmark bereaved in 1997-2014, for 17 years. Prospectively recorded register data were obtained for civil and vital status, 39 mental and physical diagnoses, and socioeconomic factors.
In total, 389 316 bereaved individuals were identified and 137 247 died during follow-up. Bereaved individuals had higher all-cause mortality than non-bereaved references in the entire study period. The relative mortality in the bereaved individuals was highest shortly after the loss (adjusted hazard ratio (aHR), first month: 2.50, 95% confidence interval (CI) 2.37-2.63; aHR, 6-12 months: 1.38, 95% CI 1.34-1.42). The excess mortality rate associated with bereavement rose with increasing number of physical diseases (1.33 v. 7.00 excess death per 1000 person-months for individuals with 0 v. ⩾3 physical conditions during the first month) and was exacerbated by the presence of mental illness. The excess mortality among bereaved individuals was primarily due to death from natural causes.
Bereavement was associated with increased short-term and long-term mortality, even after adjustment for morbidities, which suggests that mental stress may play a causal role in excess mortality.
精神压力与更高的死亡率有关，但精神压力负荷高的人死亡率更高是由于身体疾病负担更高还是因果关系仍存在争议。当开发有针对性的干预措施时，了解因果关系很重要。我们旨在通过使用配偶丧亲作为与疾病无关的精神压力源来进行“自然”实验，估计精神压力对死亡率的影响。
我们对丹麦在 1997-2014 年丧偶的所有人进行了一项基于人群的匹配队列研究，随访 17 年。前瞻性地记录了公民身份和生命状态、39 种精神和身体诊断以及社会经济因素的登记数据。
总共确定了 389316 名丧偶者，随访期间有 137247 人死亡。在整个研究期间，丧偶者的全因死亡率高于非丧偶者。丧偶者的相对死亡率在丧亲后不久最高（调整后的危险比（aHR），第一个月：2.50，95%置信区间（CI）2.37-2.63；aHR，6-12 个月：1.38，95%CI 1.34-1.42）。与丧偶相关的超额死亡率随着身体疾病数量的增加而增加（第一个月内患有 0 种与 ⩾3 种身体状况的个体为 133 人，而 1000 人月中有 700 人死亡），并且与精神疾病的存在有关。丧偶者的超额死亡率主要归因于自然原因导致的死亡。
即使在调整了发病情况后，丧偶仍与短期和长期死亡率增加有关，这表明精神压力可能在超额死亡率中起因果作用。
