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Psychological distress, neuroticism, and cause-specific mortality: Early prospective evidence from UK Biobank

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Original languageEnglish
Pages (from-to)1136-1139
JournalJournal of Epidemiology & Community Health
Issue number11
Early online date12 Aug 2016
Publication statusE-pub ahead of print - 12 Aug 2016


Background: It is well established that psychological distress (depression and anxiety) is related to an increased risk of mortality. The personality trait of neuroticism, reflecting a relatively stable tendency towards negative emotions, has also been associated with elevated rates of death in some studies. Accordingly, we tested the possibility that it is the neuroticism trait itself, rather than the distress state, that is generating an elevated risk of mortality. Methods: We used data from the United Kingdom Biobank study, a UK-wide prospective cohort investigation (2006-10) in which distress was ascertained using the Patient Health Questionnaire and neuroticism using the Eysenck Personality Questionnaire-Revised Short Form. Results: A mean of 6.2 years of follow-up of 308,721 study members gave rise to 4334 deaths. Higher neuroticism was weakly associated with total mortality (age- and sex-adjusted hazard ratio per standard deviation increase; 95% confidence interval: 1.05; 1.02, 1.09), and moderately strongly correlated with distress symptoms (r=0.55, p<0.0001). Distress symptoms were positively related to risk of total mortality (age- and sex-adjusted hazard ratio per standard deviation increase in distress; 95% confidence interval: 1.23; 1.20, 1.26). This gradient was, in fact, slightly strengthened after adding neuroticism to the multivariable model (1.30; 1.26, 1.34) but markedly attenuated after taking into account other covariates which included health behaviours and somatic disease (1.16; 1.12, 1.20). Similar results were apparent when cardiovascular disease, cancer, and external cause of death were the endpoints of interest. Conclusion: While there was good a priori reasons to anticipate the neuroticism would at least partially explain the relation between distress symptoms and cause-specific mortality, we found no such evidence in the present study.

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