Internalizing psychopathology and all‐cause mortality: a comparison of transdiagnostic vs. diagnosis‐based risk prediction

Abstract

Previous studies have documented the utility of a transdiagnostic internalizing factor in predicting important future outcomes (e.g., subsequent mental disorder diagnoses). To date, however, no study has investigated whether an internalizing factor predicts mortality risk. Also, while pre­vious studies of mortality risk have emphasized its associations with particular internalizing disorders, no study has assessed how the transdiagnostic internalizing factor vs. disorder‐specific variance differently predict that risk. The primary aims of this study were to explore: a) whether the internalizing factor predicts mortality risk, b) whether particular internalizing psychopathologies uniquely predict mortality risk over and beyond the transdiagnostic internalizing factor, and c) whether there is a significant interaction of internalizing with self‐reported health in the prediction of mortality risk. We utilized a large national sample of American adults from the Midlife in the United States (MIDUS), a longitudinal study that examined midlife development of individuals across multiple waves between 1995 and 2015. Data were analyzed for the 6,329 participants who completed the phone interview and self‐administered questionnaire in MIDUS 1 (1995‐1996) and were then followed up until October 31, 2015 or until death. To investigate the association between internalizing and mortality risk, we used the semi‐parametric proportional hazards Cox model, where survival time was regressed on a latent internalizing factor. Overall findings indicate that a transdiagnostic internalizing factor significantly predicts mortality risk over a 20‐year period (hazard ratio, HR=1.12, 95% CI: 1.05‐1.16, p<0.01) and that internalizing outperforms disorder‐specific variance (e.g., depression‐specific variance) in the prediction of that risk. Further, there was a significant interaction between transdiagnostic internalizing and self‐reported health, whereby internalizing psychopathology had a specific association with early death for individuals with excellent self‐reported health condition (HR=1.50, 95% CI: 1.17‐1.84, p<0.05). This highlights the clinical utility of using the transdiagnostic internalizing factor for prediction of an important future outcome, and supports the argument that internalizing psychopathology can be a meaningful liability to explore in public health practice.

Translating the hierarchical taxonomy of psychopathology (HiTOP) from potential to practice: Ten research questions.

“…Typically, more global, multifaceted outcomes (e.g., school failure) correlate strongest with broad individual differences (e.g., externalizing superspectrum, p factor), whereas less complex outcomes (e.g., managing one’s study time) are traced to narrower traits (e.g., inattention). For example, research finds that the internalizing spectrum predicts mortality (a very complex outcome with manifold causal influences), whereas individual DSM anxiety and depressive diagnoses (e.g., major depressive disorder, panic disorder) contribute little additional predictive utility (Kim et al, 2021).…”

The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research

“…Dimensions were found to predict clinical improvement, treatment needs, and community functioning – in the short-term and long-term – across various outpatient and inpatient populations (Cervin et al, 2021; Conway et al, 2021; Forbush et al, 2018; Martin et al, 2021; Morey et al, 2012). HiTOP also outperformed traditional diagnoses in predicting important life outcomes, such as all-cause mortality (Kim et al, 2021).…”

For whom the bell tolls: psychopathological and neurobiological correlates of a DNA methylation index of time-to-death

“…These underlying spectra of psychopathology offer a useful framework for evaluating shared health burden across individual psychiatric disorders as they may have greater biological relevance than individually defined disorders [ 8 ]. Consistent with this, there is evidence that the internalizing dimension, which underlies individual mood and anxiety disorders, is associated with a greater ability to predict mortality risk over a 20-year period relative to individual disorders alone [ 9 ]. This suggests that psychiatric distress shared across internalizing disorders is a common factor that increases the risk for premature morbidity and mortality.…”