Psychological Distress, Life Expectancy, and All-Cause Mortality in the United States: Results from the 1997-2014 NHIS-NDI Record Linkage Study.

BACKGROUND: Previous research has shown a significant association between psychological distress (PD) and all-cause mortality. However, this association is not fully explored, and life expectancy by PD is unknown.

METHODS: We used the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N=513,081) to examine the association of the Kessler 6-item psychological distress scale with life expectancy and all-cause mortality. Life expectancy by PD was computed using the standard life table method. Cox regression was used to model survival time as a function of PD and sociodemographic, behavioral, and health characteristics.

RESULTS: The age-adjusted mortality rate for adults with serious psychological distress (SPD) was 2,632 deaths per 100,000 person-years, compared with 1,428 for those without PD. Life expectancy was inversely related to PD. At age 18, those with SPD had a life expectancy of 45.0 years, compared with 55.6 years for those without PD. The age-adjusted relative risk of all-cause mortality was 125% higher for adults with SPD (hazard ratio [HR]=2.25; 95% CI=2.14,2.37) than those without PD. Mortality risk associated with SPD remained (HR=1.14; 95% CI=1.08,1.20) after covariate adjustment.

CONCLUSIONS: US adults with SPD had significantly higher mortality risk and lower life expectancy.