The British Journal of Psychiatry


The association between affective disorders and subsequent death from physical disease is a subject which has received little attention. The present investigation into this aspect is based on a four year follow-up study of an unselected group of 135 patients admitted to a psychiatric hospital. The observed mortality rates for males suffering from simple anxiety state and depression were significantly raised. In contrast, none of the female patients showed a similar increase. Further, deaths from carcinoma among male patients with depression were significantly more frequent than expected.

Certain aspects of the nature of the aetiological relationship between physical disease and affective disorders are discussed. While a depressive reaction to the awareness of physical illness may have contributed to the association between psychiatric and somatic disease in those patients dying from causes other than carcinoma, this does not account for the course of events in the carcinoma group. It is suggested that a form of depressive illness in male patients arising in late middle age without previous psychiatric illness and occurring without apparent cause may be an early and direct manifestation of latent carcinoma. The clinical picture is of a 'mixed' type with features of both reactive and endogenous depression. The immediate response to ECT and anti-depressant drugs is good but transient. Whereas neurological prodro-mata occur more commonly in association with carcinoma of the lung, depressive illness appears to bear no specific relationship to the site of the tumour. It is emphasized that further and more extensive studies are required to evaluate the present findings.