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Invited Commentary
Jan 14, 2013

Differential Mortality for Persons With Psychological Distress and Low Socioeconomic StatusWhat Does It Mean and What Can Be Done?
Comment on “The Combined Association of Psychological Distress and Socioeconomic Status With All-Cause Mortality”

Author Affiliations

Author Affiliations: Departments of Psychiatry and Biobehavioral Sciences and Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine (Drs Wells and Miranda), Jonathan and Karin Fielding School of Public Health, Department of Health Services, (Dr Wells), University of California, Los Angeles, and The RAND Corporation Health Program (Dr Wells), Los Angeles, California.

JAMA Intern Med. 2013;173(1):27-28. doi:10.1001/jamainternmed.2013.1542

We have long known that people who live in poverty have shorter life expectancies than those who are better off.1 Similarly, psychological distress is a risk factor for early mortality.2 Lazzarino and colleagues3 provide evidence that the effect of psychological distress on mortality is greater among adults of lower socioeconomic status (SES). The finding is based on 66 518 adults completing the Health Survey for England in 1 of 10 years (1994-2004), with survey data linked to mortality data to 2008 (mean follow-up of 8 years). Their analysis relied on a brief measure of psychological distress (symptoms of anxiety and depression, low confidence, and social dysfunction), an occupation measure (categories from managerial/professional to unskilled), and adjustment for age, sex, body mass index, smoking, and diabetes mellitus and for hypertension and physical activity in sensitivity analyses. They found that occupational status and psychological distress had significant main effects on mortality and an interaction reflecting a stronger effect of distress on mortality among persons of lower social class. The authors featured all-cause mortality but found similar conclusions for mortality due to stroke and coronary heart disease and for men and women, older and younger adults, and early and late survey cohorts.

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