Programme no. 529-OP
The impact of perceived stress on mortality among persons with multimorbidity: a population-based cohort study
Anders Prior*1, Karen Kjær Larsen2, Finn Breinholt Larsen3, Mogens Vestergaard4, Morten Fenger-Grøn5, Kirstine Magtensgaard Robinson6, Marie Mortensen7, Kaj Sparle Christensen8, Stewart Mercer9
1Research Unit For General Practice, Department of Public Health,Aarhus University,Aarhus,Denmark, 2Section for General Medical Practice,Aarhus University,Aarhus,Denmark, 3Public Health and Quality Improvement,Central Denmark Region,Aarhus,Denmark, 4Research Unit For General Practice, Department of Public Health,Aarhus University,Aarhus,Denmark, 5Research Unit For General Practice,Aarhus University,Aarhus,Denmark, 6Research Centre for Prevention and Health, Glostrup University Hospital,The Capital Region of Denmark,Glostrup,Denmark, 7Research Unit For General Practice, Department of Public Health,Aarhus University,Aarhus,Denmark, 8Research Unit For General Practice, Department of Public Health,Aarhus University,Aarhus,Denmark, 9General Practice and Primary Care, Institute of Health and Wellbeing,University of Glasgow,Glasgow,United Kingdom
* = Presenting author
Objectives: In the present study, we aimed to investigate the impact of perceived stress on mortality in patients with multimorbidity.
Background: Multimorbidity (two or more long-term conditions) is now common in populations worldwide. Increasing levels of multimorbidity are associated with poorer psychological wellbeing, and the association aggravates with increasing number of physical conditions. However, no studies have evaluated whether mental health status affects the prognosis of multimorbidity.
Results: During 453,567 person-years at risk, we identified 4,220 deaths of which 3,220 (76%) were persons with multimorbidity. Mortality increased with increasing level of perceived stress after adjusting for physical and mental conditions, lifestyle and socioeconomic factors (lowest vs highest PSS quintile, adjusted hazard ratio 1.47, 95% CI 1.32-1.64). The highest mortality was found among persons with severe multimorbidity (four or more conditions) in the highest PSS quintile (adjusted hazard ratio 4.21, 95% CI 3.48-5.10) compared to persons with no multimorbidity in the lowest PSS quintile. Perceived stress increased mortality independently of multimorbidity status in a dose-response relationship (tests for linear trend p<0.0001 for each multimorbidity group). The association was equally strong among persons with low and high levels of education.
Material/Methods: We performed a population-based cohort study of 118,411 persons (25 years or older) participating in the Danish National Health Survey of 2010, who were followed until 2014. From the survey, we obtained exposure information on perceived stress using Cohen’s Perceived Stress Scale (PSS) along with life-style and socioeconomic covariates. This was combined with individual health register data on multimorbidity by pooling registered diagnoses and redeemed drug prescriptions in an algorithm defining 39 conditions. Our outcome was all-cause mortality.
Conclusion: Our study suggests that psychological wellbeing is as an important prognostic factor for death in persons with multimorbidity even when taking lifestyle, socioeconomic status and morbidity burden into account. These findings confirm that patients should be seen in a biopsychosocial context. Personalised care with a strong focus on mental health is essential when treating persons with multimorbidity.
Points for discussion: How well is mental-physical multimorbidity handled in primary care today? Are patients offered opportunistic screening for mental health problems? Which interventions may prove effective in clinical care?