Psychological Distress and All-Cause, Cardiovascular Disease, Cancer Mortality Among Adults with and without Diabetes

• Main Authors: Huang W, Aune D, Ferrari G, Zhang L, Lan Y, Nie J, Chen X, Xu D, Wang Y, Rezende LFM
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-07-01
• Series: Clinical Epidemiology
• Subjects: diabetes mellitus; psychological distress; mortality; cohort
• Online Access: https://www.dovepress.com/psychological-distress-and-all-cause-cardiovascular-disease-cancer-mor-peer-reviewed-fulltext-article-CLEP

Wentao Huang,1 Dagfinn Aune,2– 4 Gerson Ferrari,5 Lei Zhang,6 Yutao Lan,1 Jing Nie,7 Xiong Chen,8 Dali Xu,9 Yafeng Wang,10 Leandro FM Rezende11 1School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China; 2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; 3Department of Nutrition, Bjørknes University College, Oslo, Norway; 4Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; 5Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile; 6Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, People’s Republic of China; 7Department of Sociology & Institute for Empirical Social Science Research, School of Humanities and Social Sciences, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 8Department of Endocrinology, Wenzhou Medical University First Affiliated Hospital, Wenzhou, Zhejiang, People’s Republic of China; 9Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People’s Hospital, Wenzhou, Zhejiang, People’s Republic of China; 10Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, People’s Republic of China; 11Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, Sao Paulo, BrazilCorrespondence: Dali XuDepartment of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People’s Hospital, Wenzhou, Zhejiang, People’s Republic of ChinaEmail [e-mail] HuangSchool of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of ChinaEmail [e-mail]: To examine the association of psychological distress with all-cause, cardiovascular disease (CVD) and cancer mortality in US adults, and verified whether the associations differed between participants with and without diabetes.Methods: A total of 485,864 adults (446,288 without diabetes and 39,576 with diabetes) who participated in the National Health Interview Survey from 1997 to 2013 were linked to the National Death Index through December 31, 2015. Psychological distress was measured by the Kessler 6 distress scale (K6). Multivariable Cox proportional hazards regression models were performed to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between psychological distress and mortality.Results: We ascertained 11,746 deaths (mean follow-up,  7. 7 years) among people with diabetes and 51,636 deaths (9.9 years) among those without diabetes. Psychological distress was associated with higher all-cause, CVD, and cancer mortality. Compared to non-diabetic adults without psychological distress, HRs (95% CI) were 1.07 (1.04 to 1.09) for mild, 1.26 (1.22 to 1.30) for moderate and 1.46 (1.38 to 1.55) for severe psychological distress. Compared to the same reference group, in diabetic participants the HRs were 1.39 (1.33 to 1.44) for no psychological distress, 1.59 (1.53 to 1.66) for mild, 1.90 (1.80 to 2.00) for moderate and 1.98 (1.82 to 2.17) for severe psychological distress. Similar associations were also observed for CVD and cancer mortality but with non-statistically significant interaction.Conclusion: Psychological distress was associated with higher mortality, particularly in participants with diabetes. Strategies to ameliorate psychological distress may be important to reduce mortality in this population.Keywords: diabetes mellitus, psychological distress, mortality, cohort