The British Journal of Psychiatry (2009) 195: 118-125. doi: 10.1192/bjp.bp.108.054866
© 2009 The Royal College of Psychiatrists
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Levels of anxiety and depression as predictors of mortality: the HUNT study

Arnstein Mykletun, PhD

Research Centre for Health Promotion, Faculty of Psychology, University of Bergen, Norway, and Institute of Psychiatry, King's College London, UK and Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway

Ottar Bjerkeset, MD, PhD

Department of Research and Development, Levanger Hospital, Norway, and Department of Neuroscience, Unit for Psychiatry and Behavioral Science, Faculty of Medicine, National University of Science and Technology, Trondheim, Norway

Simon Øverland, PhD

Research Centre for Health Promotion, Faculty of Psychology, University of Bergen, Norway

Martin Prince, MD, MRCPsych, PhD, Michael Dewey, PhD and Robert Stewart, MD PhD

Institute of Psychiatry, King's College London, UK

Correspondence: Arnstein Mykletun, Mental Health Epidemiology, Research Centre of Health Promotion, Faculty of Psychology, University of Bergen, Christiesgt 13 N-5015 Bergen, Norway. Email: Arnstein.Mykletun{at}uib.no

Declaration of interest

None.

Funding

R.S. is funded by NIHR Biomedical Research Centre for Mental Health, the South London and Maudsley NHS Trust, and the Institute of Psychiatry, King's College London.

Background

Depression is reported to be associated with increased mortality, although underlying mechanisms are uncertain. Associations between anxiety and mortality are also uncertain.

Aims

To investigate associations between individual and combined anxiety/depression symptom loads (using the Hospital Anxiety and Depression Scale (HADS)) and mortality over a 3–6 year period.

Method

We utilised a unique link between a large population survey (HUNT–2, n = 61 349) and a comprehensive mortality database.

Results

Case-level depression was associated with increased mortality (hazard ratio (HR) = 1.52, 95% CI 1.35–1.72) comparable with that of smoking (HR = 1.59, 95% CI 1.44–1.75), and which was only partly explained by somatic symptoms/conditions. Anxiety comorbid with depression lowered mortality compared with depression alone (anxiety depression interaction P = 0.017). The association between anxiety symptom load and mortality was U-shaped.

Conclusions

Depression as a risk factor for mortality was comparable in strength to smoking. Comorbid anxiety reduced mortality compared with depression alone. The relationship between anxiety symptoms and mortality was more complex with a U-shape and highest mortality in those with the lowest anxiety symptom loads.


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