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Invited Commentary |

Differential Mortality for Persons With Psychological Distress and Low Socioeconomic Status:  What Does It Mean and What Can Be Done?
Comment on “The Combined Association of Psychological Distress and Socioeconomic Status With All-Cause Mortality”

Kenneth B. Wells, MD, MPH; Jeanne Miranda, PhD
JAMA Intern Med. 2013;173(1):27-28. doi:10.1001/jamainternmed.2013.1542.
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We have long known that people who live in poverty have shorter life expectancies than those who are better off.1 Similarly, psychological distress is a risk factor for early mortality.2 Lazzarino and colleagues3 provide evidence that the effect of psychological distress on mortality is greater among adults of lower socioeconomic status (SES). The finding is based on 66 518 adults completing the Health Survey for England in 1 of 10 years (1994-2004), with survey data linked to mortality data to 2008 (mean follow-up of 8 years). Their analysis relied on a brief measure of psychological distress (symptoms of anxiety and depression, low confidence, and social dysfunction), an occupation measure (categories from managerial/professional to unskilled), and adjustment for age, sex, body mass index, smoking, and diabetes mellitus and for hypertension and physical activity in sensitivity analyses. They found that occupational status and psychological distress had significant main effects on mortality and an interaction reflecting a stronger effect of distress on mortality among persons of lower social class. The authors featured all-cause mortality but found similar conclusions for mortality due to stroke and coronary heart disease and for men and women, older and younger adults, and early and late survey cohorts.

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