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Psychol Med. 2018 Jul;48(9):1437-1443. doi: 10.1017/S0033291717002380. Epub 2017 Aug 30.

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

Author information

1
Research Unit for General Practice,Department of Public Health,Aarhus University,Bartholins Allé 2, Aarhus,Denmark.
2
Department of Psychiatry and Behavioral Sciences,University of Washington,Box 359911,325 Ninth Ave,Seattle, WA,USA.
3
Department of Clinical Epidemiology,Aarhus University Hospital,Olof Palmes Allé 43-45,Aarhus N,Denmark.

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:

Bereavement; comorbidity; epidemiology; mental health; mortality; multimorbidity; psychological; stress; widowhood

PMID:
28851470
DOI:
10.1017/S0033291717002380
[Indexed for MEDLINE]

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