Suboptimal baseline mental health associated with 4-month premature all-cause mortality: Findings from 18 years of follow-up of the Canadian National Population Health Survey

• Authors: Esme Fuller-Thomson, University of Toronto; Yu Lung, University of Toronto; Keri J. West, University of Toronto; Corey Keyes, Emory University; Philip Baiden, The University of Texas at Arlington
• Journal Title: Journal of Psychosomatic Research
• Volume: Volume 136
• Publisher: Elsevier | 2020-09-01, Pages 110176-110176
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.jpsychores.2020.110176
• Subjects: Sociology, Public and Social Welfare; Health Sciences, Mental Health; Health Sciences, Public Health; Sociology, Social Structure and Development
• Keywords: Flourishing; Mental health; Mortality; Positive mental health; Risk factors; Adolescent; Adult; Aged; Canada; Female; Follow-Up Studies; Humans; Male; Mental Health; Middle Aged; Mortality, Premature; Population Health; Risk Factors; Surveys and Questionnaires; Time Factors; Young Adult

Abstract

Objective To investigate: 1) whether baseline non-flourishing mental health is associated with a higher probability of all-cause mortality over 18-year follow-up after controlling for many risk factors for premature mortality; and 2) what other factors, independent of mental health status, are associated with all-cause mortality after adjustment for known risk factors. Methods Data were derived from waves 1 and 9 (1994/1995; 2010/2011) of the Canadian National Population Health Survey. An analytic sample of 12,424 participants 18 years and above was selected. Baseline information on flourishing and predictors of all-cause mortality was from wave 1 and mortality data was ascertained by the Canadian Vital Statistics-Death Database in wave 9. Mean time to all-cause mortality was estimated using Kaplan-Meir procedure. Cox proportional hazards models were used to assess the association of baseline non-flourishing mental health and potential predictors with time to all-cause mortality. Results About one in five participants was classified as non-flourishing at baseline. At the end of the study period 2317 deaths were observed. Baseline non-flourishing mental health was associated with a 19% higher probability of all-cause mortality during 18-year follow-up (HR = 1.19; 95% CI 1.08–1.32), corresponding to a 4.7-month shorter survival time. After controlling for baseline chronic health conditions, past-year depression, sociodemographics, health behaviors, social support, pain and functioning, baseline non-flourishing mental health status was associated with a 14% higher probability of death (HR = 1.14; 95% CI 1.02–1.27). Conclusions Suboptimal mental health is associated with premature mortality even after accounting for many risk factors for early death. Future research should explore the physiological pathways through which non-flourishing influences mortality.