TitlePsychological Distress and Risk of Accidental Death in the General Population.
Publication TypeJournal Article
Year of Publication2016
AuthorsBatty, GD, Stamatakis, E, Bell, S
Date Published11/2016
KeywordsAccidents, Female, Follow-Up Studies, Health Surveys, Humans, Male, Risk Factors, Stress, Psychological, United Kingdom


To the Editor:While accidents are a major cause of disability and mortality worldwide, their etiology is not well understood. Risk factors appear to include socioeconomic deprivation, lower cognitive function, and being male, older, and unmarried/living alone.1–3 Investigators have also shown that severe mental illness is associated with an elevated risk of accidents2; however, these observations are exclusive to individuals with mental disorders serious enough to warrant hospitalization4 or referral to an outpatient clinic. To the best of our knowledge, there has been no examination of the link between lower levels of distress as ascertained from enquiries regarding symptoms and subsequent risk of accidents. Reasons to anticipate such a relationship include the symptoms of fatigue, poor concentration, and sleep disturbance that characterize even moderately distressed individuals, which may impact unfavorably on decision-making, risk perception, coordination, and response time, so precipitating accidents.Described in detail elsewhere,5 we used data from 16 independent, near-identical, geographically representative surveys with mortality surveillance (the Health Surveys for England [N = 13] and the Scottish Health Surveys [N = 3]). Combining these studies in the context of an individual-participant meta-analysis resulted in a total of 193,873 participants, 166,606 (86%) of whom had data on age, sex, and psychological distress. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12) which contains items principally concerned with symptoms of depression and anxiety.6 The sensitivity (0.70) and specificity (0.80) against standardized psychiatric interview is acceptably high.7 Study members also reported if they had ever been diagnosed with a psychiatric disorder and if they had used prescribed psychotropic medications. We computed hazard ratios using Cox proportional hazard models in which we accounted for between study variation using a shared frailty parameter. We used fractional polynomials to estimate the best-fitting dose–response curve.In analyses of baseline data, as anticipated, we found that a higher prevalence of both self-reported psychiatric morbidity and psychotropic medications was apparent in the more psychologically distressed study members (eFigure 1; http://links.lww.com/EDE/B95). For instance, in people in the most distressed group (GHQ-12 score 12), 31% reported using psychotropic medications, whereas in the least distressed group (GHQ-12 score 0), the corresponding proportion was 2%.A mean duration of 9.5 years of follow-up of 166,606 people (91,528 women) gave rise to 340 deaths ascribed to all accidents combined. In the Figure, we show that, following multivariable adjustment, an increase in the rate of accidental deaths occurred at a distress score of above 3. After excluding study members with either self-declared psychiatric morbidity or use of psychotropic medications (111,848 people; 218 accidental deaths), however, hazard ratios became elevated at the lowest level of distress symptoms. A test for trend indicated a dose–response relationship across the full range of distress scores (P value for trend ≤0.001), with a 1-SD increase in psychological distress associated with an increase in risk of accidents after multiple adjustment (1.17; 1.04, 1.33). In eTable 1 (http://links.lww.com/EDE/B95), we present the risk of accidents according to standard categorization of psychological distress (“asymptomatic,” “subclinical symptomatic,” “symptomatic,” “highly symptomatic”).5 Relative to the asymptomatic group, there was around a doubling of risk in the study members classified as highly symptomatic.In this, to our knowledge, the first population-based study in the context of psychological distress symptoms and accidental death, we found that accident rates were raised even in people with low levels of distress. That our analyses also revealed known risk factors for accidents (eTable 2; http://links.lww.com/EDE/B95)—gender (male vs. female: 1.80; 1.45, 2.

Alternate JournalEpidemiology
PubMed ID27479648
Grant ListMR/K026992/1 / / Medical Research Council / United Kingdom