From the Department of Epidemiology & Public Health, University College London, London, United Kingdom.
Division Surgery & Interventional Science, University College London, London, United Kingdom.
Epidemiology. 2021 Sep 1;32(5):740-743. doi: 10.1097/EDE.0000000000001374.
The onset of psychological distress most commonly occurs in adolescence and, in keeping with other exposures, is time-varying across the life course. Most studies of its association with mortality risk are, however, conducted in middle- and older-aged populations with a single baseline assessment. This may lead to an underestimation of the magnitude of distress-mortality relationship.
We used data from the 1970 British Cohort Study, a prospective cohort study. Psychological distress and covariates were collected at ages 5, 10, and 26. Vital status was ascertained between ages 26 and 44 years.
Eighteen years of mortality surveillance of 5,901 individuals (3,221 women) gave rise to 74 deaths. After adjustment for a series of confounding factors which included early life socioeconomic status, birth characteristics, and cognition, relative to the unaffected group, distress in childhood only was associated with around a 50% elevation in mortality risk (hazard ratio = 1.45; 95% confidence interval = 0.84, 2.51), whereas distress in adulthood only was related to a doubling of risk (1.95; 0.90, 4.21). In study members with persistent distress symptoms (childhood and adulthood), there was a tripling of the death rate (3.10; 1.42, 6.74) (P value for trend across these categories: 0.002).
The suggestion of a strong association between life-course distress and death warrants replication in a study with a greater number of events.
心理困扰的发作通常发生在青春期，与其他暴露因素一样，在整个生命过程中是随时间变化的。然而，大多数关于其与死亡率风险关联的研究都是在中年和老年人群中进行的，且只有一次基线评估。这可能导致对困扰与死亡率关系的严重程度的低估。
我们使用了 1970 年英国队列研究的数据，这是一项前瞻性队列研究。心理困扰和协变量在 5、10 和 26 岁时收集。在 26 至 44 岁之间确定了生存状态。
对 5901 名个体（3221 名女性）进行了 18 年的死亡率监测，有 74 人死亡。在调整了一系列混杂因素后，包括早期社会经济地位、出生特征和认知，与未受影响组相比，只有儿童期的困扰与死亡率风险增加约 50%相关（风险比=1.45；95%置信区间=0.84，2.51），而只有成年期的困扰与风险增加一倍相关（1.95；0.90，4.21）。在持续存在困扰症状（儿童期和成年期）的研究参与者中，死亡率增加了两倍（3.10；1.42，6.74）（这些类别之间的趋势检验 P 值：0.002）。
生活过程中的困扰与死亡之间存在强烈关联的提示需要在具有更多事件的研究中进行复制。
