Poor psychological health and 8-year mortality: a population-based prospective cohort study stratified by gender in Scania, Sweden

ObjectivesWe investigated gender differences in the association between mortality and general psychological distress (measured by 12-item General Health Questionnaire, GHQ-12), as an increased mortality risk has been shown in community studies, but gender differences are largely unknown. SettingWe used data from a cross-sectional population-based public health survey conducted in 2008 in the Swedish region of Skane (Scania) of people 18-80 years old (response rate 54.1 %). The relationship between psychological distress and subsequent all-cause and cause-specific mortality was examined by logistic regression models for the total study population and stratified by gender, adjusting for age, socioeconomic status, lifestyle (physical activity, smoking, alcohol consumption), and chronic disease. ParticipantsOf 28 198 respondents, 25 503 were included in analysis by restrictive criteria. Outcome measuresOverall and cause-specific mortality by 31 December 2016.ResultsMore women (20.2 %) than men (15.7 %) reported psychological distress at baseline (GHQ >= 3). During a mean follow-up of 8.1 years, 1389 participants died: 425 (30.6%) from cardiovascular diseases, 539 (38.8%) from cancer, and 425 (30.6%) from other causes. The overall association between psychological distress and mortality risk held for all mortality end-points except cancer after multiple adjustments (eg, all-cause mortality OR 1.8 (95 % CI 1.4 to 2.2) for men and women combined. However, stratification revealed a clear gender difference as the association between GHQ-12 and mortality was consistently stronger and more robust among men than women. ConclusionMore women than men reported psychological distress while mortality was higher among men (ie, the morbidity-mortality gender paradox). GHQ-12 could potentially be used as one of several predictors of mortality, especially for men. In the future, screening tools for psychological distress should be validated for both men and women. Further research regarding the underlying mechanisms of the gender paradox is warranted.

Automated summary

This study investigated the association between mortality and general psychological distress, measured by the GHQ-12, and found gender differences in the association. The study revealed a higher prevalence of psychological distress among women, but higher mortality rates among men, highlighting the morbidity-mortality gender paradox. GHQ-12 could potentially be used as a predictor of mortality, especially for men.