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Psychological distress, neuroticism, and cause-specific mortality: early prospective evidence from UK Biobank
  1. G David Batty1,
  2. Andrew M McIntosh2,
  3. Tom C Russ3,
  4. Ian J Deary3,
  5. Catharine R Gale3,4
  1. 1Department of Epidemiology and Public Health, University College London, London, UK
  2. 2Division of Psychiatry, University of Edinburgh, Edinburgh, UK
  3. 3Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
  4. 4MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  1. Correspondence to Dr G David Batty, Department of Epidemiology and Public Health, University College London, London, 1-19 Torrington Place, London, UK, WC1E 6BT.E.; david.batty{at}


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 increased risk of mortality.

Methods We used data from the UK Biobank study, a UK-wide prospective cohort study (2006–2010) 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-adjusted and sex-adjusted HR per SD increase; 95% CI 1.05; 1.02 to 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-adjusted and sex-adjusted HR per SD increase in distress; 95% CI 1.23; 1.20 to 1.26). This gradient was, in fact, slightly strengthened after adding neuroticism to the multivariable model (1.30; 1.26 to 1.34) but markedly attenuated after taking into account other covariates which included health behaviours and somatic disease (1.16; 1.12 to 1.20). Similar results were apparent when cardiovascular disease, cancer and external cause of death were the end points of interest.

Conclusions 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.

  • Cohort studies

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  • Contributors CRG, AMM, GDB were involved in study concept and design; CRG was involved in acquisition and preparation of the data set (including mortality linkage); CRG was involved in statistical analysis; all authors were involved in interpretation of the data; GDB and CRG were involved in drafting of the manuscript; all authors were involved in critical revision of the manuscript for important intellectual content. CRG had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors saw and agreed on the final manuscript as well as the decision to submit for publication.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from the National Health Service National Research Ethics Service.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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