American Journal of Epidemiology Advance Access first published online on July 2, 2008
This version published online on July 4, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn147
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Invited Commentary: Stress and Mortality
1 Section of General Hospital Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom
2 MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
Correspondence to Professor Matthew Hotopf, Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, United Kingdom (e-mail: m.hotopf{at}iop.kcl.ac.uk).
Received for publication February 1, 2008. Accepted for publication February 28, 2008.
In this issue of the Journal, Nielsen et al. (Am J Epidemiol 2008;168:000–00) use data from a large Danish study to provide evidence that self-reported stress is associated with increased all-cause mortality over the next 20 years. The finding is remarkable. In this commentary, the authors explore what is really meant by stress; they argue that it would be naïve to view stress as reported in this way, with some external exposure. It has to be seen through the lens of the participant's personal experience, and this lens is likely to be clouded by personality, coping styles, and the common mental disorders—depression and anxiety. The authors discuss a wider literature concerning similar findings associating depression with mortality, suggesting three broad reasons for the association. First, the findings might be explained by the impact of stress or distress on well-established risk factors for cardiovascular disease and cancer. Second, there might be direct, underlying psychosomatic pathways by which stress or distress can affect immune or autonomic function. Third, there might be common causal pathways—shared genes or early adversities that predict both stress and mortality from other causes independently. The authors suggest that life course epidemiologic research is required to test these competing hypotheses.
cause of death; depressive disorder; mortality; prospective studies; stress, psychological
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