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Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4933 (Published 31 July 2012) Cite this as: BMJ 2012;345:e4933

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Re: Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies

This article on links between psychological distress and mortality (1) is important for two reasons.

Firstly, the linkages between immune function and depression and its consequences to morbidity and mortality are becoming increasingly recognised (2).

The second reason lies hidden in Figure 2 of this study where a cycle in mortality over time can be observed with a notable minimum in 2002. This minimum is shared with international trends relating to medical and mental health hospital admissions and bed occupancy (3-11), A&E attendance (12) and GP referrals, especially to Mental Health (13), the incidence of particular cancers (14) and deaths (15).

My interest in this phenomenon has been largely directed to the financial and operational consequences of such cycles and, as such, this work has been published in a management journal (16-20).It has been proposed that these cycles arise from recurring ‘outbreaks’ of some form of infectious immune impairment.

Cytomegalovirus has been tentatively proposed as a likely candidate given its known immune impairing effects, links with depression and particular cancers (21). A study investigating the proposal that these cycles arise from infectious ‘outbreaks’ is about to be published in September. In this study the increase in GP referrals at different locations in Scotland and Wales at monthly intervals have been investigated following the 2007 ‘outbreak’ to reveal a time-dependant patchwork spread of sudden increases in GP referral (22).

Unfortunately the data on mortality and psychological distress in the work of Maes et al was only available up to 2004 and it will be interesting to see if the measures of mortality reach another minimum in 2007. Further study is required to see if the linkage with immune function can also be demonstrated although it has already been largely inferred (2)and to see if the infectious outbreak hypothesis is related to these effects.

References

1.Russ T, Hamer M, Starr J, Kivimäki M, Batty G. Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ 2012;345:e4933

2.Maes M, Berk M, Goehler L et al. Depression and sickness behaviour are Janus-faced responses to shared inflammatory pathways. BMC Medicine 2012; 10: 66

3.Jones R. Trends in emergency admissions. British Journal of Healthcare Management 2009; 15(4): 188-196.

4.Jones R. Cycles in emergency admissions. British Journal of Healthcare Management 2009; 15(5): 239-246.

5.Jones R. Emergency admissions and hospital beds. British Journal of Healthcare Management 2009; 15(6): 289-296.

6.Jones R. Emergency admissions and financial risk. British Journal of Healthcare Management 2009; 15(7): 344-350.

7.Jones R. Unexpected, periodic and permanent increase in medical inpatient care: man-made or new disease. Medical Hypotheses 2010; 74: 978-83.

8.Jones R. Can time-related patterns in diagnosis for hospital admission help identify common root causes for disease expression. Medical Hypotheses 2010; 75: 148-154.

9.Jones R. The case for recurring outbreaks of a new type of infectious disease across all parts of the United Kingdom. Medical Hypotheses 2010; 75(5): 452-457.

10.Jones R. Emergency preparedness. British Journal of Healthcare Management 2010; 16 (2): 94-95.

11.Jones R. Bed occupancy – the impact on hospital planning. British Journal of Healthcare Management 2011; 17(7): 307-313.

12.Jones R. Forecasting emergency department attendances. British Journal of Healthcare Management 2010; 16(10): 495-496.

13.Jones R. Are there cycles in outpatient costs? British Journal of Healthcare Management 2012; 18(5): 276-277.

14.Jones R. Financial risk in commissioning: cancer costs. British Journal of Healthcare Management 2012; 18(6): 315-324.

15.Jones R. End of life and financial risk in GP commissioning. British Journal of Healthcare Management 2012; 18(7): 374-381.

16.Jones R. Nature of health care costs and financial risk in commissioning. British Journal of Healthcare Management 16(9): 424-430.

17.Jones R. Trends in programme budget expenditure. British Journal of Healthcare Management 16(11): 518-526.

18.Jones R. Cycles in inpatient waiting time. British Journal of Healthcare Management 17(2): 80-81.

19.Jones R. Time to re-evaluate financial risk in GP commissioning. British Journal of Healthcare Management 2012; 18(1): 39-48.

20.Jones R. Why is the ‘real world’ financial risk in commissioning so high? British Journal of Healthcare Management 2012; 18(4): 216-217.

21.Jones R. Could cytomegalovirus be causing widespread outbreaks of chronic poor health? Hypotheses in Clinical Medicine, Chapter 4; Eds M. Shoja et al., New York: Nova Science Publishers Inc (due 4th quarter 2012).

22.Jones R. Unexplained increases in GP referrals: collective jump or infectious push? British Journal of Healthcare Management 2012; 18(9): in press.

Competing interests: The author provides consultancy to healthcare organisations.

03 August 2012
Rodney P Jones
Statistical Advisor
Healthcare Analysis & Forecasting
Honister Walk, Camberley