title: Psychological distress measured by the GHQ-12 and mortality: a prospective population-based study.
abstract: OBJECTIVE
  To examine whether persons with psychological distress have a greater risk of all-cause mortality in the Scandinavian population; whether this association is gender-specific; and what is the influence of socioeconomic status, body mass index (BMI) and health behaviour in this association.
  
  
  METHODS
  A total of 923 (414 male and 509 female) people, aged 36 to 56 years, participated in a population-based study from 1997-98 in Pieksämäki, Finland. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 points were summed to a global score ranging from 0-12. Mortality data until 31 December 2009 were drawn from the national mortality register.
  
  
  RESULTS
  There were 44 death events (27 men, 17 women) during the mean observation time of 11 years. The hazard ratio (HR) increased by 16% for every GHQ-12 point (gender and age adjusted HR 1.16, 95% confidence interval (95% CI): 1.07-1.25, p < 0.001). In the fully adjusted model with gender, age, socioeconomic status, BMI, smoking and physical activity, HR was 1.13 (95% CI: 1.04-1.22, p = 0.003). In men, the 10-year survival for distressed (GHQ-12 score ≥ 4) participants was 84% (95% CI: 73- 91) and for non-distressed (GHQ-12 score 0-3) participants it was 96% (95% CI: 93-97), HR = 3.38 (95% CI: 1.55-7.39, p = 0.002). Among women, no significant association was found.
  
  
  CONCLUSIONS
  Psychological distress measured by the GHQ-12 is associated with all-cause mortality risk during an 11-year observation time. This is mainly due to excess mortality among distressed men.
authors.affiliation: Centre for Social and Health Services, Kuopio, Finland. puustinenpekka@hotmail.com
authors.forename: Pekka Johannes
authors.initials: PJ
authors.lastname: Puustinen
authors.forename: Hannu
authors.initials: H
authors.lastname: Koponen
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Pekka
authors.initials: P
authors.lastname: Mäntyselkä
authors.forename: Mauno
authors.initials: M
authors.lastname: Vanhala
mesh_terms: D000328:Adult; D002423:Cause of Death; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications / Q000401:mortality*; D011795:Surveys and Questionnaires