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Self-Reported Mental Health-Related Quality of Life and Mortality in Men and Women in the European Prospective Investigation into Cancer (EPIC-Norfolk): A Prospective Population Study

From the Department of Public Health and Primary Care (P.K.M., R.N.L., P.G.S., N.W.J.W., A.A.W., K.-T.K.), University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, UK; MRC Centre for Nutrition and Cancer (S.A.B.), Cambridge, UK; MRC Epidemiology Unit (N.J.W.), Elsie Widdowson Laboratories, Cambridge, UK; School of Medicine (P.K.M., R.D.S., I.M.H.), Health Policy and Practice, University of East Anglia, Norwich, UK.

Address correspondence and reprint requests to P. K. Myint, Clinical Gerontology Unit, Box-251, Level 2, F&G Block, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. E-mail: Pkyawmyint{at}aol.com

Objective: To explore the relationship between self-reported mental functional health and mortality.

Methods: Participants included 17,777 men and women aged 40 to 79 years at baseline who lived in Norfolk, UK, and had no known cardiovascular disease or cancer, and completed the anglicized Short Form 36-item questionnaire (UK SF-36) during 1996 to 2000 in the European Prospective Investigation into Cancer-Norfolk prospective population study. We examined the relationship between mental functional health derived from the mental component summary scores of the SF-36 and mortality from all causes, cardiovascular disease, cancer, and other causes during an average 6.5-year follow-up.

Results: There were 1065 deaths during a total of 115,550 person-years of follow-up. Impaired mental health-related quality of life was associated with increased risk of all-cause mortality in men and women. A decrease of 1 SD (10 points) in SF-36 mental component summary scores was associated with a 14% increase in all-cause mortality (hazards ratio = 1.14; 95% Confidence Interval: 1.07, 1.21) after controlling for age, gender, body mass index, systolic blood pressure, cholesterol, alcohol consumption, diabetes, smoking, social class, and physical functional health.

Conclusion: Poor self-reported mental functional health is related to increased risk of all-cause mortality in men and women. Interpretation of this association requires further investigation.

Key Words: self-reported mental functional health • HLEQ • UK SF-36 • all-cause mortality

Abbreviations: UK SF-36 = Anglicized version of short form 36-item questionnaire; HRQL = health-related quality of life; MCS = mental component summary; EPIC-Norfolk = European Prospective Investigation into Cancer-Norfolk; BMI = body mass index; HLEQ = Health and Life Experiences Questionnaire; HR = hazards ratio; ICD-9 = Ninth Revision of the International Classification of Diseases; ICD-10 = Tenth Revision of the International Classification of Diseases; PCS = Physical Component Summary.