Psychopathology and mortality in the general population

  • A. Kouzis
  • W. W. Eaton
  • P. J. Leaf
Original Paper


Community studies of the relationship between mortality and mental disorders remain equivocal with mixed and unclear results. Longitudinal prospective data from the Epidemiologic Catchment Area Program are examined for the relationship between psychopathology and mortality. Analyses were performed with mortality at 1-year follow-up as the dependent variable using logistic regression. Specifically, the odds of dying from psychiatric disorders were considered while statistically adjusting for sociodemographic characteristics and treatment in primary or specialty medical care sectors. Significant predictors of dying were being male, older, and from low income households. Subjects with drug abuse or dependence were 12.4 times (CI=2.9, 53.0) as likely to die as those, without drug abuse/dependence. The odds of dying for those with major depressive disorder were over 2.6 times (CI=1.1, 6.0) those without major depression. Separate analyses for all five communities and for only those over the age of 55 years showed similar results.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Allebeck P, Wistedt B (1986) Mortality in schizophrenia: a ten-year follow-up based on the Stockholm County inpatient register. Arch Gen Psychiatry 43: 650–653Google Scholar
  2. American Psychiatric Association (1980) Diagnostic statistical manual of mental disorders, third edition American Psychiatric Association, Washington, D.C.Google Scholar
  3. American Psychiatric Association (1993) Practice guideline for major depressive disorder in adults. Am J Psychiatry [Suppl] 150: 1–26Google Scholar
  4. Babigian HM, Odoroff CL (1969) The mortality experience of a population with psychiatric illness. Am J Psychiatry 126: 470–480Google Scholar
  5. Berkman LF, Syme SL (1979) Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol 109: 186–204Google Scholar
  6. Black DW, Warrack G, Winokur G (1985 a) The Iowa record-linkage study. I. Suicides and accidental deaths among psychiatric patients. Arch Gen Psychiatry 42: 71–75Google Scholar
  7. Black DW Warrack G, Winokur G (1985 b) The Iowa record-link-age study. II. Excess mortality among patients with organic mental disorders. Arch Gen Psychiatry 42: 78–81Google Scholar
  8. Black DW, Warrack G, Winokur G (1985 c) The Iowa record-linkage study. III. Excess mortality among patients with ‘functional’ disorders. Arch Gen Psychiatry 42: 82–88Google Scholar
  9. Bruce ML, Leaf PJ (1989) Psychiatric disorders and 15-month mortality in a community sample of older adults. Am J Public Health 79: 727–730Google Scholar
  10. Bruce ML, Leaf PJ, Rozal GPM, Florio L, Hoff RA (1994) Psychiatric status and 9-year mortality in the New Haven Epidemiologic Catchment Area study. Am J Psychiatry 151: 716–721Google Scholar
  11. Cleary PD, Angel R (1984) The analysis of relationships involving dichotomous dependent variables. J Health Soc Behav 25: 334–348Google Scholar
  12. Coate D (1993) Moderate drinking and coronary heart disease mortality: evidence from NHANES I and the NHANES I follow-up. Am J Public Health 83: 888–890Google Scholar
  13. Cottler LB, Zipp JF, Robins LN, Spitznagel EL (1987) Difficult to recruit respondents and their effect on prevalence estimates in an epidemiologic survey. Am J Epidemiol 125: 329–339Google Scholar
  14. Eaton WW, Kessler LG (eds) (1985) Epidemiologic field methods in psychiatry: the NIMH Epidemiologic Catchment Area Program. Academic Press. OrlandoGoogle Scholar
  15. Eaton WW, Regier DA, Locke BZ, Taube CA (1981) The Epidemiologic Catchment Area program in the National Institute of Mental Health. Publ Health Rep 96: 319–325Google Scholar
  16. Eaton WW, Holzer CE, Von Korff M, Anthony JC, Helzer JE, George LK, Burnam MA, Boyd JH Kessler LG, Locke BZ (1984) The design of the Epidemiologic Catchment Area surveys. Arch Gen Psychiatry 41: 942–948Google Scholar
  17. Egolf B, Lasker J, Wolf S, Potvin L (1992) The roseto effect: a 50-year comparison of mortality rates. Am J Public Health 82: 1089–1092Google Scholar
  18. Fleiss JL, Williams JB, Dubro AF (1986) The logistic regression analysis of psychiatric data. J Psychiatr Res 20: 145–209Google Scholar
  19. Fredman L, Schoenbach VJ Kaplan BH, Blazer DG, James SA, Kleinbaum DG, Yankaskas B (1989) The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey. J Gerontol Soc Sci 44: S149-S156Google Scholar
  20. Goldberg E, Comstock GW, Hornstra RK (1979) Depressed mood and subsequent physical, illness. Am J Psychiatry 136: 530–534Google Scholar
  21. House JS Robbins C, Metzner HL (1982) The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health study. Am J Epidemiol 116: 123–140Google Scholar
  22. Kendler KS (1986) A twin study of mortality in schizophrenia and neurosis. Arch Gen Psychiatry 43: 643–649Google Scholar
  23. Kessler LG, Folsom R, Royall R, Forsythe A, McEvoy L, Holzer CE III, Rae DS, Woodbury M (1985) Parameter and variance estimation. In: Eaton WW, Kessler LG (eds) Epidemiologic field methods in psychiatry: the NIMH Epidemiologic Catchment Area Program. Academic Press, Orlando, pp 327–349Google Scholar
  24. Klerman GL (1989) Depressive disorders: further evidence for increased medical morbidity and impairment of social functioning. Arch Gen Psychiatry 46: 856–858Google Scholar
  25. Klerman GL, Weissman MM (1992) The course, morbidity, and costs of depression. Arch Gen Psychiatry 49: 831–834Google Scholar
  26. Leaf PJ, Livingston MM, Tischler GL, Weissman MM Holzer CE, Myers JK (1985) Contact with health professionals for the treatment of psychiatric and emotional problems. Med Care 26: 9–26Google Scholar
  27. Leaf PJ, Myers JK, McEvoy LT (1991) Procedures used in the Epidemiologic Catchment Area Study. In: Robins LN, Regier DA (eds) Psychiatric disorders in America: the Epidemiologic Catchment Area Study. The Free Press, New York, pp 11–32Google Scholar
  28. Linn S, Carroll M, Johnson C, Fulwood R, Kalsbeek W, Briefel R (1993) High-density lipoprotein cholesterol and alcohol consumption in US white and black adults: data from NHANES II. Am J Public Health 83: 811–816Google Scholar
  29. Manderscheid RW, Rae DS, Narrow WE, Locke BZ, Regier DA (1993) Congruence of service utilization estimates from the Epidemiologic Catchment Area Project and other sources. Arch Gen Psychiatry 50: 108–114Google Scholar
  30. Marmot M, Brunner E (1991) Alcohol and cardiovascular disease: the status of the U-shaped curve. BMJ 303: 565–568Google Scholar
  31. Martin RL, Cloninger R, Guze SB, Clayton PJ (1985 a) Mortality in a follow-up of 500 psychiatric outpatients. I. Total mortality. Arch Gen Psychiatry 42: 47–54Google Scholar
  32. Martin RL, Cloninger R, Guze SB, Clayton PJ (1985 b) Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality. Arch Gen Psychiatry 42: 58–66Google Scholar
  33. Murphy JM, Monson RR, Olivier DC, Sobol AM, Leighton AH (1987) Affective disorders and mortality: a general population study. Arch Gen Psychiatry 44: 473–480Google Scholar
  34. Murphy E, Smith R, Lindesay J, Slattery J (1988) Increased mortality rates in late-life depression. Br J Psychiatry 152: 347–353Google Scholar
  35. Narrow WE, Regier DA, Donald SR, Manderscheid R, Locke BZ (1993) Use of services by persons with mental and addictive disorders: findings from the National Institute of Mental Health Epidemiologic Catchment Area program. Arch Gen Psychiatry 50: 95–107Google Scholar
  36. Pappas G, Queen S, Hadden W, Fisher G (1993) The increasing disparity in mirtality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med 329: 103–109Google Scholar
  37. Peele S (1993) The conflict between public health goals and the temperance mentality. Am J Public Health 83: 805–810Google Scholar
  38. Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ (1978) The NIMH Epidemiologic Catchment Area program: historical context, major objectives, and study population characteristics. Arch Gen Psychiatry 41: 934–941Google Scholar
  39. Regier DA, Narrow W, Rae DS, Manderscheid R, Locke BZ, Goodwin FK (1993) The de facto US mental and addictive disorders service system: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry 50: 85–94Google Scholar
  40. Rice DP, MacKenzie EJ et al. (1989) Cost of injury in the US: a report to Congress. Institute for Health & Aging, University of California and Injury Prevention Center, The Johns Hopkins University, San FranciscoGoogle Scholar
  41. Rice DP, Kelman S, Miller LS, Dunmeryer S (1990) The economic costs of alcohol and drug abuse and mental illness: 1985 Report submitted to the Office of Financing and Coverage Policy of the Alcohol, Drug Abuse, and Mental Health Administration, U.S. Department of Health and Human Services. Institute for Health and Aging, University of California, San FranciscoGoogle Scholar
  42. Robins LN, Helzer JE, Croughan J, Ratcliff KS (1981) The National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics and validity. Arch Gen Psychiatry 38: 381–389Google Scholar
  43. Sceman I (1992) Sampler of findings from the 1986 national mortality followback survey on risk factors, disability, and health care. Public Health Rep 107: 707–712Google Scholar
  44. Shapiro S, Tischler GL, Cottler L, George LK, Amirkhan JH, Kessler LG, Skinner EA (1985) Health services research questions. In: Eaton WW, Kessler LG (eds) Epidemiologic field methods in psychiatry: The NIMH Epidemiologic Catchment Area Program. Academic, Orlando, pp 191–208Google Scholar
  45. Shapiro S, Skinner EA, Kessler LG, Von Korff M, German PS, Tischler GL, Leaf PJ, Benham L, Cottler L, Regier DA (1986a) Utilization of health and mental health services: three, epidemiologic catchment area sites. Arch Gen Psychiatry 41: 972–978Google Scholar
  46. Shapiro S, Skinner EA, German PS, Kramer M, Romanoski A (1986b) Need and demand for mental health services in an urban community: an exploration based on household interviews. In: Barrett J (ed) Mental disorder in a community: progress and challenge. Guilford, New York, pp 307–320Google Scholar
  47. Singer E, Garfinkel R, Cohen SM, Srole L (1976) Mortality and mental health: evidence from the Midtown Manhattan restudy. Soc Sci Med 10: 517–525Google Scholar
  48. Suh I, Shaten BJ, Cutler JA, Kuller LH (1992) Alcohol use and mortality from coronary heart disease: the role of high density lipoprotein. Ann Intern Med 116: 881–887Google Scholar
  49. Tsuang MT, Simpson JC (1985) Mortality studies in psychiatry. Arch Gen Psychiatry 42: 98–103Google Scholar
  50. “US sets tragic record as teer firearm deaths hit new high”. The Nation's Health, April, 1993, p20Google Scholar
  51. Weissman MM, Myers JK, Thompson WD, Belanger A (1986) Depressive symptoms as a risk factor for mortality and for major depression. In: Erlanmeyer-Kimling L, Miller NE (eds) Life span research, on the prediction of psychopathology. Erlbaum, Hillsdale, N. J., pp. 251–260Google Scholar
  52. Wells KB, Burnam MA, Rogers W, Hays R, Camp P (1992) The course of depression in adult outpatients: results from the medical outcomes study. Arch Gen Psychiatry 49: 788–794Google Scholar
  53. Wilkinson RG (1992) Strong differences between income distribution within the society contirute to determine national mortality. Am J Public Health 82: 1082–1084Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • A. Kouzis
    • 1
  • W. W. Eaton
    • 1
  • P. J. Leaf
    • 1
  1. 1.School of Hygiene and Public Health, Department of Mental HygieneTohns Hopkins UniversityBaltimoreUSA

Personalised recommendations