title: Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women.
abstract: OBJECTIVE
  Research on emotional distress and mortality has largely focused on depression in men and in elderly populations. We examined the relation between anxiety and mortality in women at midlife, adjusting for depression.
  
  
  METHODS
  At baseline, 5,073 healthy Dutch women aged 46-54 years (mean=50.4+/-2.1) and living in Eindhoven, completed a three-item anxiety scale ("being anxious/worried," "feeling scared/panicky," "ruminating about things that went wrong;" Cronbach's alpha=0.77). The primary outcome was all-cause mortality at 10-year follow-up; secondary outcomes were cardiovascular and lung/breast cancer death.
  
  
  RESULTS
  At follow-up, 114 (2.2%) women had died at the mean age of 56.4+/-3.1 years. Lung cancer (23%), cardiovascular disease (18%), and breast cancer (15%) were the major causes of death. Smoking, living alone, and lower education were related to mortality, but depression was not. Adjusting for these variables, anxiety was associated with a 77% increase in mortality risk (hazard ratio [HR]=1.77, 95% confidence interval [CI]: 1.14-2.74, P=0.011). Anxiety was related to cardiovascular death (HR=2.77, 95% CI: 1.17-6.58, P=0.021); there was also a trend for lung cancer death (HR=1.91, 95% CI: 0.90-4.06, P=0.095) but not for breast cancer death.
  
  
  CONCLUSIONS
  Anxiety predicted premature all-cause and cardiovascular death in middle-aged women, after adjustment for standard risk factors and depression.
authors.affiliation: Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. denollet@uvt.nl
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Kristel
authors.initials: K
authors.lastname: Maas
authors.forename: André
authors.initials: A
authors.lastname: Knottnerus
authors.forename: Jules J
authors.initials: JJ
authors.lastname: Keyzer
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Pop
mesh_terms: D001008:Anxiety Disorders / Q000401:mortality*; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000523:psychology; D002423:Cause of Death; D003866:Depressive Disorder / Q000401:mortality; D004522:Educational Status; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012847:Single Person / Q000706:statistics & numerical data; D012907:Smoking / Q000523:psychology