Multimorbidity is common and is associated with poor mental health and high mortality. Nevertheless, no studies have evaluated whether mental health may affect the survival of people with multimorbidity. We investigated the association between perceived stress and mortality in people with multimorbidity by following a population-based cohort of 118,410 participants from the Danish National Health Survey 2010 for up to 4 years. Information on perceived stress and lifestyle was obtained from the survey. We assessed multimorbidity using nationwide register data on 39 conditions and identified 4,229 deaths for the 453,648 person-years at risk. Mortality rates rose with increasing levels of stress in a dose-response relationship (P-trend < 0.0001), independently of multimorbidity status. Mortality hazard ratios (highest stress quintile vs. lowest) were 1.51 (95% confidence interval (CI): 1.25, 1.84) among persons without multimorbidity, 1.39 (95% CI: 1.18, 1.64) among those with 2 or 3 conditions, and 1.43 (95% CI: 1.18, 1.73) among those with 4 or more conditions, when adjusted for disease severities, lifestyle, and socioeconomic status. The numbers of excess deaths associated with high stress were 69 among persons without multimorbidity, 128 among those with 2 or 3 conditions, and 255 among those with 4 or more conditions. Our findings suggested that perceived stress contributes significantly to higher mortality rates in a dose-response pattern, and more stress-associated deaths occurred in people with multimorbidity.

ObjectivesMental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental–physical multimorbidity.DesignPopulation-based cohort study.SettingPrimary healthcare in Denmark.Participants118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers.Outcome measuresGeneral daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers.ResultsPerceived stress levels were associated with primary care activity in a dose–response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services.ConclusionPersons with high stress levels generally had higher use of primary healthcare, 4–6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.

Background-Myocardial infarction (MI) is associated with an increased risk of anxiety, depression, low quality of life, and all-cause mortality. Whether MI is associated with an increased risk of suicide is unknown. We examined the association between MI and suicide. Methods and Results-We conducted a population-based case-control study by retrieving data from 5 nationwide longitudinal registers in Denmark. As cases, we selected all persons aged 40 to 89 years who died by suicide from 1981 to 2006. As controls, we randomly selected up to 10 persons per case matched by sex, day of birth, and calendar time.We identified 19 857 persons who committed suicide and 190 058 controls. MI was associated with a marked increased risk of suicide. The risk of suicide was highest during the first month after discharge for MI for patients with no history of psychiatric illness (adjusted rate ratio, 3.25; 95% confidence interval, 1.61 to 6.56) and for patients with a history of psychiatric illness (adjusted rate ratio, 64.05; 95% confidence interval, 13.36 to 307.06) compared with those with no history of MI or psychiatric illness. However, the risk remained high for at least 5 years after MI. Conclusions-MI is followed by an increased risk of suicide for persons with and without psychiatric illness. Our results suggest the importance of screening patients with MI for depression and suicidal ideation. (Circulation.

Post-MI anxiety symptoms were not an independent prognostic risk factor for new cardiovascular events or for death, whereas depressive symptoms were associated with an increased risk of mortality.