Neuroticism and cardiovascular disease mortality: socioeconomic status modifies the risk in women (UK Health and Lifestyle Survey).

OBJECTIVE: The association between personality traits and mortality might differ as a function of socioeconomic status (SES). Our aim was to evaluate the all-cause, cardiovascular disease (CVD), and cancer mortality risk associated with neuroticism or extraversion and their interactions with SES in a representative sample of the UK adult population. METHODS: A total of 5450 participants (2505 men) from the Health and Lifestyle Survey completed the Eysenck Personality Inventory at baseline and were monitored for vital status over 25 years. SES was defined as a latent variable comprising occupational social class, educational attainment, and income. RESULTS: A significant neuroticism-by-SES-by-sex interaction (p = .04) for CVD mortality revealed a neuroticism-by-SES interaction specific to women. Compared to women with average SES, those with both high neuroticism and low SES were at an increased risk for CVD mortality (hazard ratio = 2.02, 95% confidence interval = 1.45-2.80), whereas those with high neuroticism and high SES combined were at a decreased risk for CVD mortality (hazard ratio = 0.61, 95% confidence interval = 0.38-0.97, p for interaction = 0.003). The interaction term was not explained by health behaviors (10% attenuation) and physiological variables (11% attenuation). This interaction was not observed for all-cause and cancer mortality risks or among men for CVD mortality. CONCLUSIONS: High neuroticism is a risk factor for cardiovascular mortality in women with low SES, whereas in women with higher SES, it is protective. Further research is needed to replicate this finding and identify the mechanisms behind the modifying effect of SES on neuroticism.

[Comorbide somatic pathology in servicemen with neurotic disorders].

Prevalence and structure of comorbidity a somatic pathology in military men with neurotic disorders was studied. It was established that 40,4% of surveyed noted concomitant somatic pathology, the structure of which was dominated by gastro-intestinal tract (26,8%), and pathology of the cardiovascular system (21,6%). It is shown that concomitant somatic pathology provided aggravating effect on clinic neurotic disorders in serviceman, making it difficult to diagnose mental disorders. The greatest risk concomitant a somatic pathology was marked in patients with depressive and somatoform disorders. Indicates the need for specialized standards of care for persons with comorbid mental and somatic disorders.

Recovered or dead? A Swedish study of 321 persons surveyed as severely mentally ill in 1995/96 but not so ten years later.

AIM: The aim was to follow-up a group of persons who were considered severely and persistently mentally ill (SMI) at the time of the 1995 Swedish mental health-care reform but not so ten years later. METHODS: Surveys were conducted in 1995/96 and 2006 in an area of Sweden. Of 602 persons surveyed as SMI in 1995/96, 321 were not found to be so in a similar survey in 2006. These persons were followed up concerning death rates and causes, as well as concerning recovery and present care. Comparisons between subgroups were made using the results of interviews conducted in 1995/96. RESULTS: Nineteen percent of the persons considered SMI in 1995/96 were recovered in 2006 in the sense that they no longer were considered SMI. The only variable found to predict recovery was diagnosis. Half of the persons in the sample given a diagnosis of neurosis were recovered but only 6% of those given a diagnosis of psychosis. Death rates and death causes seemed to be in line with previous research. CONCLUSIONS: Relatively few persons were considered recovered after ten years. Most persons in the sample were still in contact with care and services.

Methods of suicide in different psychiatric diagnostic groups.

BACKGROUND: An important element in suicide risk assessment is the evaluation of the intended suicide method. This study aimed to compare suicide methods in different psychiatric diagnostic groups in Taiwan. METHODS: A total of 12,391 adult suicide cases between 2000 and 2004, which were recorded in official death records, were linked to Taiwan's National Health Insurance data files. A descriptive study was conducted to compare methods of suicide across different psychiatric diagnostic groups. RESULTS: The proportion of jumping suicide was particularly high in cases with more severe psychopathology. Compared to suicide victims without any history of psychiatric disease, the odds ratios (OR) and 95% confidence interval (CI) of jumping suicide among schizophrenic, bipolar, and major depressive patients were 3.1 (95% CI: 2.6-3.7), 2.2 (95% CI: 1.8-2.7), and 1.9 (95% CI: 1.6-2.2), respectively. Charcoal burning was less frequently used by those with a history of psychiatric diagnosis. LIMITATIONS: It is difficult to determine the reliability and validity of the claim data. Information on non-fatal acts of self-harm is unavailable. CONCLUSIONS: Suicide victims with different psychiatric diagnoses vary in their choice of suicide methods.

Pessimistic, anxious, and depressive personality traits predict all-cause mortality: the Mayo Clinic cohort study of personality and aging.

OBJECTIVE: To study the association between several personality traits and all-cause mortality. METHODS: We established a historical cohort of 7216 subjects who completed the Minnesota Multiphasic Personality Inventory (MMPI) for research at the Mayo Clinic from 1962 to 1965, and who resided within a 120-mile radius centered in Rochester, MN. A total of 7080 subjects (98.1%) were followed over four decades either actively (via a direct or proxy telephone interview) or passively (via review of medical records or by obtaining their death certificates). We examined the association of pessimistic, anxious, and depressive personality traits (as measured using MMPI scales) with all-cause mortality. RESULTS: A total of 4634 subjects (65.5%) died during follow-up. Pessimistic, anxious, and depressive personality traits were associated with increased all-cause mortality in both men and women. In addition, we observed a linear trend of increasing risk from the first to the fourth quartile for all three scales. Results were similar in additional analyses considering the personality scores as continuous variables, in analyses combining the three personality traits into a composite neuroticism score, and in several sets of sensitivity analyses. These associations remained significant even when personality was measured early in life (ages 20-39 years). CONCLUSIONS: Our findings suggest that personality traits related to neuroticism are associated with an increased risk of all-cause mortality even when they are measured early in life.

Predictive validity of the total health index for all-cause mortality assessed in the Komo-Ise cohort.

BACKGROUND: The Total Health Index (THI), a self-administered questionnaire developed in Japan, is used for symptom assessment and stress management of employees and others; however, it has not been reported whether it can predict mortality risk. METHODS: The THI, with 12 primary and 5 secondary scales, was applied to a cohort consisting of middle-aged residents in Japan. This study, called the Komo-Ise cohort study, was started in 1993. The scale scores were related to 481 deaths from all causes among 10,816 residents over 93 months. The statistics were tested by the Cox hazard model and adjusted for three background variables (sex, age, and district where the subject resided). RESULTS: Five of the scales [depression and aggression (primary scales), and psychosomatics, neurotics, and schizophrenics (secondary scales)] indicated significant hazard ratios for mortality. The lowest quintile group of the aggression scale score had the largest hazard ratio of 2.58, compared with the middle quintile group (95% confidence interval: 1.88-3.52). The psychosomatics, neurotic scales and depression scales also had a minimum hazard ratio in the middle quintile group. One of the secondary scales, T1, which represents a somatoform disorder, had a significant linear relationship with the mortality risk, although its proportionality with the cumulative mortality rates was not satisfactory. CONCLUSIONS: Five scales of the THI were significantly related to mortality risk in the Komo-Ise cohort, which could be used for score evaluation and in the personal health advice system of the THI.

Neuroticism, extraversion, and mortality in the UK Health and Lifestyle Survey: a 21-year prospective cohort study.

OBJECTIVE: To examine the influence of neuroticism and extraversion on all-cause and cause-specific mortality over 21 years after controlling for risk factors. METHODS: Participants were members of the Health and Lifestyle Survey, a British nationwide sample survey of 9003 adults. At baseline (1984 to 1985), individuals completed a sociodemographic and health questionnaire, underwent physical health examination, and completed the Eysenck Personality Inventory. Mortality was assessed for 21 years after baseline. A total of 5424 individuals had complete data. RESULTS: After controlling for age and gender, 1-standard deviation (SD) increase in neuroticism was related to 9% (hazard ratio (HR) = 1.09; 95% Confidence Interval (CI) = 1.03-1.16) increased risk of mortality from all causes. The association was nonsignificant (HR = 1.05; 95% CI = 0.99-1.11) after additionally controlling for occupational social class, education, smoking, alcohol consumption, physical activity, and health. There was 12% (HR = 1.12; 95% CI = 1.03-1.21) increased risk of death from cardiovascular disease associated with 1-SD increase in neuroticism. This was still significant after adjustment. When the sample was divided into 40- to 59-year-olds and those >or=60 years, neuroticism remained a significant risk for all-cause mortality and cardiovascular disease mortality; associations were nonsignificant after controlling for all covariates. Neuroticism was not associated with deaths from stroke, respiratory disease, lung cancer, or other cancers. Extraversion was protective of death from respiratory disease (HR = 0.84; 95% CI = 0.70- 1.00). CONCLUSIONS: After controlling for several risk factors, high neuroticism was significantly related to risk of death from cardiovascular disease. The effects of neuroticism on death from cardiovascular disease may be mediated by sociodemographic, health behavior, and physiological factors.

Personality change influences mortality in older men.

Previous studies have indicated that high neuroticism is associated with early mortality. However, recent work suggests that people's level of neuroticism changes over long periods of time. We hypothesized that such changes in trait neuroticism affect mortality risk. Growth-curve parameters (levels and slopes) that quantified the trajectories of neuroticism change over 12 years were used to predict 18-year risk of mortality among 1,663 aging men. Proportional hazards models were used to estimate mortality risk from level and slope parameters, controlling for objective and subjective health, depression, and age. Although a parallel analysis of extraversion showed no significant effects, level and slope of neuroticism interacted in their effect on mortality. Men who had both a high average level of neuroticism and an increasing level of neuroticism over time had much lower survival than men without that combination. These findings suggest that it is not just the level of personality traits, but their direction of change, that is related to mortality.

Neurosis and mortality in persons aged 65 and over living in the community: a systematic review of the literature.

BACKGROUND: No previous attempt has been made to synthesise information on mortality and neurosis in older people. Our objective was to estimate the influence on mortality of various types of neurosis in the older population. METHODS: Data sources were: Medline; Embase; and personal files. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Studies which sampled from a larger age range were also included if it was possible to retrieve results about those aged 65 and over. Samples from health care facilities were excluded. Effect sizes were extracted from the papers and if they were not included in the published papers effect sizes were calculated if possible. No attempt was made to contact authors for missing data. RESULTS: We found seven reports (six of which used a neurosis diagnosis and one which used a symptom scale). Using Fisher's method we found an increase in mortality which was not significant (p = 0.08). CONCLUSION: There have been few studies, and the evidence is weakly in favour of an increased mortality risk.

Life expectancies for individuals with psychiatric diagnoses.

The aim of the study was to estimate life expectancies in different diagnostic groups for individuals treated as inpatients at Swedish psychiatric clinics. All individuals, older than 18 y and alive on the first of January 1983, who had been registered in the National Hospital Discharge Registry by a psychiatric clinic in 1978-82, were monitored for mortality during 1983 by using the National Cause of Death Registry. The study group consisted of 91 385 men and 77 217 women. The patients were divided into nine diagnostic groups according to the principal diagnosis registered at the latest discharge. Actuarial mathematics was used to construct life expectancy tables, which present the number of years expected to live, by gender and diagnostic group. Expectancies of life were significantly shortened for both genders and in all nine diagnostic groups (with one exception). Mental disorders in general are life shortening. This fact should be recognised in community health when setting health priorities. It should also be addressed in curricula as well as in treatment and preventive programmes.

[Physical and psychological status of 60-70-year-old citizens of Bern with neurotic symptoms in childhood--a study over more than 50 years (Emmental cohort)]. / Körperliches und psychisches Befinden bei 60-70jährigen Bernerinnen und Bernern mit neurotischen Symptomen im Kindesalter--Eine Untersuchung über mehr als 50 Jahre (Emmental-Kohorte).

The present study was undertaken to assess the influence of childhood variables (physical and emotional) to later well-being in a group of rural Swiss (Emmental Cohort). Our study is the first prospective cohort over a time period of more than 50 years. It includes 1537 children who were listed and assessed in 1942 (T1) because they had difficulties in school or were otherwise behaviorally disturbed. In 1995 (T2) more than 60% of the initial population could be reassessed by our study group. We found more subjects at T2 who had been rated as intelligent at T1. More subjects responding to T2 belonged to a higher social class, were more anxious, and had more psychosocial problems at T1. Social income at T2 is correlated to the social class at T1. More subjects have died since who were rated at T1 as being less intelligent, less neurotical, and having higher psychosocial problems. Twice as many men died than women. The emotional situation at T2 is significantly correlated to psychological well-being at T1. The somatic complaints at T2 correlate significantly to neurotic symptoms in childhood (T1). The more intelligent the children were rated at T1, the less emotional and somatic complaints were voiced at T2 and the better the psychic well-being was rated (T2). In addition, the former social milieu (T1) significantly determined somatic and psychological complaints at T2. Our data discern a significant correlation between actual status and former childhood variables more than 50 years later in a rural Swiss cohort (Emmental Cohort).

Long-term outcome of patients with neurotic illness in general practice.

OBJECTIVE: To determine the 11 year outcome of neurotic disorder in general practice. DESIGN: Cohort study over 11 years. SETTING: Two general practices in Warwickshire England. SUBJECTS: 100 patients selected to be representative of those identified nationally by general practitioners as having neurotic disorders. MAIN OUTCOME MEASURES: Mortality, morbidity, and use of health services. RESULTS: At 11 years 87 subjects were traced. The 11 year standardised mortality ratio was 173 (95% confidence interval 164 to 200). 47 were cases on the general health questionnaire, 32 had a relapsing or chronic psychiatric course, and 49 a relapsing or chronic physical course. Treatment for psychiatric illness was mainly drugs. The mean number of consultations per year was 10.8 (median 8.7). A persistent psychiatric diagnosis at one year follow up was associated with high attendance ( > 12 visits a year for 11 years) at follow up after age, sex, and physical illness were adjusted for. Severity of psychiatric illness (general health questionnaire score) at outset predicted general health questionnaire score at 11 year follow up, course of psychiatric illness, and high consultation rate. CONCLUSION: These data support the view that a neurotic illness can become chronic and is associated with raised mortality from all causes and high use of services. Such patients need effective intervention, particularly those with a more severe illness who do not recover within one year.

The mortality experience of individuals on the Salford Psychiatric Case Register. I. All-cause mortality.

BACKGROUND: Several studies, mainly non-UK based, have reported higher than expected mortality for individuals with mental illness. This investigation in Salford (England) was undertaken to determine local experiences. METHOD: An historical cohort design was employed with record linkage to determine status at study end: maximum follow-up was 18 years. All 6952 individuals with schizophrenia, neuroses, affective or personality disorders, enrolled on the psychiatric case register between 1 January 1968 and 31 December 1975 were recruited: there were 199 exclusions. Death was the study end-point. RESULTS: Observed mortality was 65% higher than expected and elevated throughout the whole of follow-up. Mortality was higher in younger ages, females and subjects born locally. Circulatory disorders, injury and poisoning each caused approximately one-third of the excess deaths. CONCLUSIONS: Documenting mortality risk has important applications for prioritisation, resource allocation, developing control programmes, evaluating service effectiveness, disease forecasting and future research.

[The correlation of stress and neurosis vulnerability in the structure of nonspecific resistance to extreme factors in intact and pregnant rats]. / O sootnoshenii stress- i nevrozouiazvimosti v strukture nespetsificheskoi rezistentnosti k ékstremal'nym faktoram u intaktnykh i beremennykh krys.

White male rats, intact and pregnant females were subjected for 3 days to deprivation of paradoxical sleep by the technique of Jouvet. The main resulting vectors of the extreme state outcome, i.e., lethality, susceptibility to stress, and neurotization, made it possible to establish corresponding levels of resistance. A relationship of each of the levels with the ability to form conditioned reflexes, initial functional interhemispheric asymmetry and behavioural status, expression of protective reactions and paradoxical sleep under conditions of an insoluble conflict situation was followed. High resistance of pregnant rats is considered to be associated with the formation of gestational ambilaterality of the brain of intact animals. Such an increase in resistance is selective as far as it concerns the organism of the pregnant and it does not ensure stability of the feto-maternal complex under extreme conditions. It was established that there was an inverse relationship between the expression of neurotic disorders of the higher nervous activity and vegeto-morphological features of acute stress. This gives reason to define more exactly the role of neurotic disorders in the pathogenesis of stress and mechanisms of resistance to extreme factors.

Suicide in the mentally ill. An epidemiological sample and implications for clinicians.

BACKGROUND: Information on risk factors associated with high rates of suicide is necessary, if suicide rates among the mentally ill are to be reduced. METHOD: We used ICD-9 E-codes to define deaths on which suicide or open (undetermined death) verdicts were returned, among residents of a catchment area defined by OPCS area codes. Relative risks of suicide and undetermined deaths for recent patients (those in contact with a psychiatric service in the year preceding death) were calculated. RESULTS: Of the 286 persons, 108 were recent patients. Eighty-four per cent suffered from schizophrenia or depression. Risks of suicide and undetermined death for these patients were 31 and 20 times, respectively, those of other residents. Social risk factors varied with diagnosis. CONCLUSION: Over 90% of recent patients were receiving medical care at time of death; not all were treated appropriately. Recognising medical and social risk factors in recent patients, and effective monitoring of treatment, is important.

Mortality of public mental health patients: a Singapore experience.

This study reports the Standardised Mortality Ratio (SMR) by age and sex among public mental health patients in Singapore. The authors also examine the differences between those who were classified as "inpatient deaths" and those who were classified as "outpatient deaths". Mortality was 5.1 times that of the general population and the SMR was most accentuated in the younger, female patients. Of the 217 deaths documented over two years, schizophrenia was the most common diagnosis. Inpatient deaths (N = 120) occurred in older patients with prior physical illness who died of natural causes. In contrast, outpatient deaths (N = 97) involved younger patients with no previous illness and the majority jumped to their deaths. Mortality studies are necessary in monitoring the efficacy of mental health provisions.

[Evaluation of mortality in hospitalized mental patients 1968-1982]. / Evolution de la mortalité des malades mentaux hospitalisés 1968-1982.

Yearly, between 1968 and 1976, and every two years from 1976 to 1982, diagnostic data based on a national classification of mental disorders were homogeneously collected in French public psychiatric hospitals. The hospitalized population was estimated by the person-year method, using data on length of stay. The number of observed deaths was compared with the number of deaths expected (Standardized mortality ratio). The standardized mortality ratio (SMR) for psychiatric inpatients were found irregularly and slightly decreasing, except among women under 45: this SMR was higher in 1982 (9.6) than in 1968 (7.4). The SMR for neuroses, in the under 55 years age group, showed a regular increase especially among women. The SMR for psychoses and mental retardation was decreasing among men. For people aged more than 55 years the SMR was decreasing for all groups of diagnosis.

A twin study of mortality in schizophrenia and neurosis.

This report examines mortality rates in the National Academy of Sciences--National Research Council Twin Registry for twins with recorded diagnoses of schizophrenia or neurosis. The standardized mortality ratio for schizophrenia was 1.77 and resulted from elevations in both traumatic and disease-related deaths. In neurosis, the standardized mortality ratio was 1.30 and was due nearly entirely to elevated rates of disease-related deaths. The pattern of mortality in monozygotic and dizygotic pairs discordant for schizophrenia and neurosis was consistent with the following hypotheses: mortality in both disorders cannot be due to the disease state per se; disease-related mortality in schizophrenia results largely from environmental factors shared by twin pairs; and mortality from trauma in schizophrenia and from diseases in neurosis results largely from genetic factors. These findings must be interpreted in the context of the limitations of the registry, which include lack of standardization and incomplete ascertainment of psychiatric disorders. A review of a subsample of records indicates that schizophrenia in the registry is broadly defined and differs considerably from the narrow DSM-III concept of the disorder.

Perspectives in the study of neuroses in contemporary psychiatric practice.

Although DSM III has removed the category of neurosis, the implied fragmentation of the generic concept has been regretted by some investigators. Since its introduction in 1769, when the term was used to denote conditions which had a hysterical and hypochondriacal character, the technical use of the term has undergone revisions and reinterpretations which at one extreme have been embedded in psychoanalytic theory, and at the other have resulted in the replacement of the single concept by a proliferation of operationally defined syndromes. The present paper discusses some of the nosological problems implicit in recent trends. Whereas depression appears in 10 ICD9 categories does the psychiatric/neurotic dichotomy in relation to depression still have meaning in the absence of the generic term 'neurotic'? The hierarchical principle is widely accepted as a basis for classification, and yet the hierarchically minor syndromes may be a source of major distress. The paper reviews epidemiological studies of prognosis and follow-up of neuroses, and shows a significant excess of mortality, which is both behavioural and organic in origin. One important difficulty with the loss of the generic term is the potential loss of generic research where, for example, evaluation of treatment of panic disorder is considered distinct from other types of anxiety and phobia. The paper argues for the practical and theoretical benefits of retaining an umbrella term such as 'neuroses'.