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Epidemiol Psychiatr Sci. 2018 Aug 14:1-8. doi: 10.1017/S2045796018000434. [Epub ahead of print]

General thoughts of death and mortality: findings from the Komo-Ise cohort, Japan.

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The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University,Huddinge, 141 89,Sweden.
School of Tropical Medicine and Global Health, Nagasaki University,1-12-4 Sakamoto, Nagasaki 852-8523,Japan.
Department of Human Ecology,Graduate School of Medicine, The University of Tokyo,7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033,Japan.
Carolina Population Center, The University of North Carolina at Chapel Hill,123 West Franklin St, Chapel Hill, NC 27516,USA.
Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujadas,42, Sant Boi de Llobregat, Barcelona 08830,Spain.


AimsDeath ideation (thinking about/wishing for one's own death, thinking that one would be better off dead) is linked to an increased mortality risk. However, comparatively little is known about more general thoughts of death (GTOD) where no wish to die or life value is expressed. This study examined whether GTOD predicted mortality in a community-based cohort of older adults.


Data came from the Komo-Ise cohort study in Gunma prefecture, Japan. The analytic sample comprised 8208 individuals (average age 61.3 (range 47-77)) who were asked in wave 2 of the study in 2000 if they had 'Thought about death more than usual, either your own, someone else's or death in general?' in the past 2 weeks. Death data were obtained from the municipal resident registration file. Cox proportional hazards regression analysis was used to examine associations.


During the follow-up period (2000-2008), there were 672 deaths. In a model adjusted for baseline covariates, GTOD were significantly associated with all-cause mortality (hazards ratio 1.66, 95% confidence interval 1.20-2.29). Stratified analyses showed an association between GTOD and mortality in men, older subjects (⩾70 years), married individuals and those with higher social support.


GTOD are associated with an increased mortality risk among older citizens in Japan. Research is now needed to determine the factors underlying this association and assess the clinical relevance of screening for GTOD in older individuals.


Death; Japan; epidemiology; mortality


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