Mild mental health problems increase risk for death

-Even mild psychologic distress increases the risk for death, the results of a large meta-analysis show, raising questions about the treatment of subclinical depression and anxiety.

Researchers found that people with subclinical General Health Questionnaire (GHQ-12) scores had an increased overall risk for death, as well as death from cardiovascular disease and external causes.

It is also the first study to establish a dose-response relationship between psychologic distress and mortality.

"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," said lead author, Tom Russ (University of Edinburgh, UK) in a press statement.

The study included data from 68,222 people in the Health Survey for England between 1994 and 2004. The authors compared participants' GHQ-12 scores with information from their death certificates. Overall, 8365 participants died during a mean follow up of 8.2 years, and 40% scored at least 1 point on the GHQ-12 scale.

The authors, reporting in the BMJ, found that the risk for overall mortality was linked to GHQ-12 score in a strong dose-response manner, even in those with low scores, indicating subclinical levels of distress. The risk for death was increased by 20% in those with GHQ-12 scores of 1-3 compared with those with scores of less than 1.

Subclinically symptomatic patients were at a 29% increased risk for cardiovascular death and for death from external causes, which also showed a similar dose-response relationship.

Additionally, deaths from cancer showed a dose-response relationship with psychologic distress but a significant increase in risk for death was only significant in those with GHQ-12 scores greater than 6, representing a high burden of symptoms.

While the relationship between severe mental illness and mortality is well-described, this study is the most robust to examine mortality in the context of mild levels of distress.

Importantly, when the authors excluded deaths within the first 5 years, these relationships held, reducing the likelihood that their findings were due to reverse causation.

The study also had further strengths: "These associations also remained after taking into account other factors such as weight, exercise, smoking, alcohol consumption and diabetes. Therefore this increased mortality is not simply the result of people with higher levels of psychological distress smoking or drinking more, or taking less exercise," said senior author, David Batty (University of Edinburgh), in a press statement.

The authors hope that their findings will provide impetus for further research into the role of treatment in patients with mild, psychologic distress.

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