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Bereavement, multimorbidity and mortality: a population-based study using bereavement as an indicator of mental stress

Published online by Cambridge University Press:  30 August 2017

A. Prior ,
M. Fenger-Grøn ,
D. S. Davydow ,
J. Olsen ,
J. Li ,
M.-B. Guldin  and
M. Vestergaard
A. Prior*
Affiliation:
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, Denmark Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, Denmark
M. Fenger-Grøn
Affiliation:
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, Denmark Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, Denmark
D. S. Davydow
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, 325 Ninth Ave, Seattle, WA, USA
J. Olsen
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark Department of Epidemiology, School of Public Health, University of California, Box 951772, Los Angeles, California, USA
J. Li
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark
M.-B. Guldin
Affiliation:
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, Denmark
M. Vestergaard
Affiliation:
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, Denmark Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus, Denmark
*
Author for correspondence: A. Prior, M.D., E-mail: anders.prior@ph.au.dk
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Abstract

Background

Mental stress is associated with higher mortality, but it remains controversial whether the association is causal or a consequence of a higher physical disease burden in those with a high mental stress load. Understanding causality is important when developing targeted interventions. We aimed to estimate the effect of mental stress on mortality by performing a ‘natural’ experiment using spousal bereavement as a disease-independent mental stressor.

Methods

We followed a population-based matched cohort, including all individuals in Denmark bereaved in 1997–2014, for 17 years. Prospectively recorded register data were obtained for civil and vital status, 39 mental and physical diagnoses, and socioeconomic factors.

Results

In total, 389 316 bereaved individuals were identified and 137 247 died during follow-up. Bereaved individuals had higher all-cause mortality than non-bereaved references in the entire study period. The relative mortality in the bereaved individuals was highest shortly after the loss (adjusted hazard ratio (aHR), first month: 2.50, 95% confidence interval (CI) 2.37–2.63; aHR, 6–12 months: 1.38, 95% CI 1.34–1.42). The excess mortality rate associated with bereavement rose with increasing number of physical diseases (1.33 v. 7.00 excess death per 1000 person-months for individuals with 0 v. ⩾3 physical conditions during the first month) and was exacerbated by the presence of mental illness. The excess mortality among bereaved individuals was primarily due to death from natural causes.

Conclusions

Bereavement was associated with increased short-term and long-term mortality, even after adjustment for morbidities, which suggests that mental stress may play a causal role in excess mortality.

Keywords

Bereavementwidowhoodstresspsychologicalmortalitymultimorbiditycomorbiditymental healthepidemiology
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 9 , July 2018 , pp. 1437 - 1443
Copyright
Copyright © Cambridge University Press 2017 

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