[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Miloyan  B, Fried  E.  A reassessment of the relationship between depression and all-cause mortality in 3,604,005 participants from 293 studies.  World Psychiatry. 2017;16(2):219-220. doi:10.1002/wps.20439PubMedGoogle ScholarCrossref
Wulsin  LR, Vaillant  GE, Wells  VE.  A systematic review of the mortality of depression.  Psychosom Med. 1999;61(1):6-17. doi:10.1097/00006842-199901000-00003PubMedGoogle ScholarCrossref
Mykletun  A, Bjerkeset  O, Dewey  M, Prince  M, Overland  S, Stewart  R.  Anxiety, depression, and cause-specific mortality: the HUNT study.  Psychosom Med. 2007;69(4):323-331. doi:10.1097/PSY.0b013e31803cb862PubMedGoogle ScholarCrossref
Geerlings  SW, Beekman  ATF, Deeg  DJH, Twisk  JWR, Van Tilburg  W.  Duration and severity of depression predict mortality in older adults in the community.  Psychol Med. 2002;32(4):609-618. doi:10.1017/S0033291702005585PubMedGoogle ScholarCrossref
White  J, Zaninotto  P, Walters  K,  et al.  Duration of depressive symptoms and mortality risk: the English Longitudinal Study of Ageing (ELSA).  Br J Psychiatry. 2016;208(4):337-342. doi:10.1192/bjp.bp.114.155333PubMedGoogle ScholarCrossref
Kuh  D, Wong  A, Shah  I,  et al.  The MRC National Survey of Health and Development reaches age 70: maintaining participation at older ages in a birth cohort study.  Eur J Epidemiol. 2016;31(11):1135-1147. doi:10.1007/s10654-016-0217-8PubMedGoogle ScholarCrossref
Stafford  M, Black  S, Shah  I,  et al.  Using a birth cohort to study ageing: representativeness and response rates in the National Survey of Health and Development.  Eur J Ageing. 2013;10(2):145-157. doi:10.1007/s10433-013-0258-8PubMedGoogle ScholarCrossref
Rutter  M.  A children’s behaviour questionnaire for completion by teachers: preliminary findings.  J Child Psychol Psychiatry. 1967;8(1):1-11. doi:10.1111/j.1469-7610.1967.tb02175.xPubMedGoogle ScholarCrossref
Xu  MK, Jones  PB, Barnett  JH,  et al.  Adolescent self-organization predicts midlife memory in a prospective birth cohort study.  Psychol Aging. 2013;28(4):958-968. doi:10.1037/a0033787PubMedGoogle ScholarCrossref
Wing  JK, Mann  SA, Leff  JP, Nixon  JM.  The concept of a ‘case’ in psychiatric population surveys.  Psychol Med. 1978;8(2):203-217. doi:10.1017/S0033291700014264PubMedGoogle ScholarCrossref
Wing  JK, Cooper  JE, Sartorius  N.  Measurement and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego Program. Cambridge University Press; 1974.
Wing  JK, Nixon  JM, Mann  SA, Leff  JP. Reliability of the PSE (ninth edition) used in a population study. Psychol Med. 1977;7(3):505-516.
Lindelow  M, Hardy  R, Rodgers  B.  Development of a scale to measure symptoms of anxiety and depression in the general UK population: the Psychiatric Symptom Frequency scale.  J Epidemiol Community Health. 1997;51(5):549-557. doi:10.1136/jech.51.5.549PubMedGoogle ScholarCrossref
Goldberg  DP, Gater  R, Sartorius  N,  et al.  The validity of two versions of the GHQ in the WHO study of mental illness in general health care.  Psychol Med. 1997;27(1):191-197. doi:10.1017/S0033291796004242PubMedGoogle ScholarCrossref
Goldberg  DP, Rickels  K, Downing  R, Hesbacher  P.  A comparison of two psychiatric screening tests.  Br J Psychiatry. 1976;129(1):61-67. doi:10.1192/bjp.129.1.61PubMedGoogle ScholarCrossref
McManus  S, Meltzer  H, Brugha  T, Bebbington  P, Jenkins  R, eds.  Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. NHS Information Centre for Health and Social Care; 2009.
Clennell  S, Kuh  D, Guralnik  JM, Patel  KV, Mishra  GD.  Characterisation of smoking behaviour across the life course and its impact on decline in lung function and all-cause mortality: evidence from a British birth cohort.  J Epidemiol Community Health. 2008;62(12):1051-1056. doi:10.1136/jech.2007.068312PubMedGoogle ScholarCrossref
Taylor  HL, Jacobs  DR  Jr, Schucker  B, Knudsen  J, Leon  AS, Debacker  G.  A questionnaire for the assessment of leisure time physical activities.  J Chronic Dis. 1978;31(12):741-755. doi:10.1016/0021-9681(78)90058-9PubMedGoogle ScholarCrossref
Ewing  JA.  Detecting alcoholism: the CAGE questionnaire.  JAMA. 1984;252(14):1905-1907. doi:10.1001/jama.1984.03350140051025PubMedGoogle ScholarCrossref
Pot  GK, Richards  M, Prynne  CJ, Stephen  AM.  Development of the Eating Choices Index (ECI): a four-item index to measure healthiness of diet.  Public Health Nutr. 2014;17(12):2660-2666. doi:10.1017/S1368980013003352PubMedGoogle ScholarCrossref
Richards  M, Stephen  A, Mishra  G.  Health returns to cognitive capital in the British 1946 birth cohort.  Longit Life Course Stud. 2010;1(3):281-296. doi:10.14301/llcs.v1i3.94Google Scholar
Hatch  SL, Mishra  G, Hotopf  M, Jones  PB, Kuh  D.  Appraisals of stressors and common mental disorder from early to mid-adulthood in the 1946 British birth cohort.  J Affect Disord. 2009;119(1-3):66-75. doi:10.1016/j.jad.2009.03.021PubMedGoogle ScholarCrossref
Jones  P, Rodgers  B, Murray  R, Marmot  M.  Child development risk factors for adult schizophrenia in the British 1946 birth cohort.  Lancet. 1994;344(8934):1398-1402. doi:10.1016/S0140-6736(94)90569-XPubMedGoogle ScholarCrossref
Little  RJ, Rubin  DB.  Statistical Analysis With Missing Data. Vol 333. John Wiley & Sons; 2014.
Penninx  BW, Guralnik  JM, Mendes de Leon  CF,  et al.  Cardiovascular events and mortality in newly and chronically depressed persons >70 years of age.  Am J Cardiol. 1998;81(8):988-994. doi:10.1016/S0002-9149(98)00077-0PubMedGoogle ScholarCrossref
White  J, Zaninotto  P, Walters  K,  et al.  Severity of depressive symptoms as a predictor of mortality: the English Longitudinal Study of Ageing.  Psychol Med. 2015;45(13):2771-2779. doi:10.1017/S0033291715000732PubMedGoogle ScholarCrossref
Bruce  ML, Leaf  PJ.  Psychiatric disorders and 15-month mortality in a community sample of older adults.  Am J Public Health. 1989;79(6):727-730. doi:10.2105/AJPH.79.6.727PubMedGoogle ScholarCrossref
Archer  G, Pikhart  H, Head  J.  Do depressive symptoms predict cancer incidence? 17-year follow-up of the Whitehall II study.  J Psychosom Res. 2015;79(6):595-603. doi:10.1016/j.jpsychores.2015.07.011PubMedGoogle ScholarCrossref
Dantzer  R, Castanon  N, Lestage  J, Moreau  M, Capuron  L. Inflammation, sickness behaviour and depression. In: Steptoe  A, ed.  Depression and Physical Illness. Cambridge University Press; 2007:265-279.
Houle  JN.  Depressive symptoms and all-cause mortality in a nationally representative longitudinal study with time-varying covariates.  Psychosom Med. 2013;75(3):297-304. doi:10.1097/PSY.0b013e31828b37bePubMedGoogle ScholarCrossref
Kelly-Irving  M, Lepage  B, Dedieu  D,  et al.  Adverse childhood experiences and premature all-cause mortality.  Eur J Epidemiol. 2013;28(9):721-734. doi:10.1007/s10654-013-9832-9PubMedGoogle ScholarCrossref
Tikhonoff  V, Hardy  R, Deanfield  J,  et al; NSHD Scientific and Data Collection Teams.  Symptoms of anxiety and depression across adulthood and blood pressure in late middle age: the 1946 British birth cohort.  J Hypertens. 2014;32(8):1590-1598. doi:10.1097/HJH.0000000000000244PubMedGoogle ScholarCrossref
Hildrum  B, Romild  U, Holmen  J.  Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway.  BMC Public Health. 2011;11:601. doi:10.1186/1471-2458-11-601PubMedGoogle ScholarCrossref
Maughan  B, Stafford  M, Shah  I, Kuh  D.  Adolescent conduct problems and premature mortality: follow-up to age 65 years in a national birth cohort.  Psychol Med. 2014;44(5):1077-1086. doi:10.1017/S0033291713001402PubMedGoogle ScholarCrossref
Jokela  M, Ferrie  J, Kivimäki  M.  Childhood problem behaviors and death by midlife: the British National Child Development Study.  J Am Acad Child Adolesc Psychiatry. 2009;48(1):19-24. doi:10.1097/CHI.0b013e31818b1c76PubMedGoogle ScholarCrossref
Tsuang  MT, Woolson  RF.  Excess mortality in schizophrenia and affective disorders: do suicides and accidental deaths solely account for this excess?  Arch Gen Psychiatry. 1978;35(10):1181-1185. doi:10.1001/archpsyc.1978.01770340031002PubMedGoogle ScholarCrossref
Goldberg  DP, Hillier  VF.  A scaled version of the General Health Questionnaire.  Psychol Med. 1979;9(1):139-145. doi:10.1017/S0033291700021644PubMedGoogle ScholarCrossref
Banks  MH.  Validation of the General Health Questionnaire in a young community sample.  Psychol Med. 1983;13(2):349-353. doi:10.1017/S0033291700050972PubMedGoogle ScholarCrossref
Colman  I, Wadsworth  MEJ, Croudace  TJ, Jones  PB.  Forty-year psychiatric outcomes following assessment for internalizing disorder in adolescence.  Am J Psychiatry. 2007;164(1):126-133. doi:10.1176/ajp.2007.164.1.126PubMedGoogle ScholarCrossref
Goodman  R, Ford  T, Simmons  H, Gatward  R, Meltzer  H.  Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample.  Br J Psychiatry. 2000;177(6):534-539. doi:10.1192/bjp.177.6.534PubMedGoogle ScholarCrossref
McManus  S, Bebbington  P, Jenkins  R, Brugha  T, eds.  Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014. NHS Digital; 2016.
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Views 3,539
    Citations 0
    Original Investigation
    April 8, 2020

    Association Between Lifetime Affective Symptoms and Premature Mortality

    Author Affiliations
    • 1MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
    • 2Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
    • 3South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
    JAMA Psychiatry. Published online April 8, 2020. doi:10.1001/jamapsychiatry.2020.0316
    Key Points

    Question  How are affective symptoms over the life course associated with mortality?

    Findings  In a British birth cohort (n = 3001), affective symptoms were assessed between adolescence and age 53 years. Those who had case-level affective symptoms 1, 2, and 3 to 4 times had 76%, 87%, and 134% higher rates of premature mortality, respectively, by age 68 years compared with those who never experienced case-level symptoms; associations were largely explained by factors in adulthood, such as self-reported health conditions, smoking, and physical activity.

    Meaning  Future research into causal pathways and potential points of intervention for premature mortality should consider affective symptom history.


    Importance  Associations between affective symptoms and mortality have been evaluated, but studies have not examined timing or cumulative exposure to affective symptoms over the life course.

    Objectives  To examine how lifetime accumulation and timing of affective symptoms are associated with mortality and identify potential explanatory factors.

    Design, Setting, and Participants  Data were obtained from the MRC National Survey of Health and Development (1946 British birth cohort), a socially stratified, population-based sample originally consisting of 5362 singleton births in England, Wales, and Scotland during March 1946. The cohort has been followed up 24 times, most recently in 2014-2015. Eligible participants included those flagged for mortality with affective symptom data available at a minimum of 3 time points (n = 3001). Data analysis was conducted from July 2016 to January 2019.

    Exposures  Affective symptoms were assessed at ages 13 to 15 years (teacher-rated questionnaire), 36 years (Present State Examination clinical semistructured interview), 43 years (Psychiatric Symptom Frequency questionnaire), and 53 years (General Health Questionnaire–28). Case-level affective symptoms were determined by those scoring in the top 16th percentile (ie, suggestive of a clinical diagnosis).

    Main Outcomes and Measures  Mortality data were obtained from the UK National Health Service Central Register from age 53 to 68 years.

    Results  Of 3001 study members (1509 [50.3%] female, 1492 [49.7%] male), 235 individuals (7.8%) died over a 15-year follow-up. After adjustment for sex, those who experienced case-level affective symptoms 1, 2, and 3 to 4 times had 76%, 87%, and 134% higher rates of premature mortality, respectively, compared with those who never experienced case-level symptoms. Case-level symptoms in adolescence only (ages 13-15 years) were associated with a 94% increased rate of mortality, which was unexplained after full adjustment for covariates (hazard ratio, 1.73; 95% CI, 1.10-2.72). Associations between participants with case-level symptoms multiple (2-4) times and mortality were predominately explained by adult health indicators and behaviors. For example, associations for those with case-level symptoms 3 to 4 times were most strongly attenuated by number of health conditions (32.1%), anxiolytic use (28.4%), lung function (24.6%), physical activity (23.9%), smoking (24.6%), antidepressant use (20.1%), diet (16.4%), pulse rate (12.7%), and adult social class (11.2%).

    Conclusions and Relevance  Lifetime accumulation of affective symptoms may be associated with an increased rate of mortality, with explanatory pathways dependent on the duration and timing of symptoms. Future research into causal pathways and potential points of intervention should consider affective symptom history.