Bereavement, multimorbidity and mortality: a population-based study using bereavement as an indicator of mental stress

Psychol Med. 2018 Jul;48(9):1437-1443. doi: 10.1017/S0033291717002380. Epub 2017 Aug 30.


Background: Mental stress is associated with higher mortality, but it remains controversial whether the association is causal or a consequence of a higher physical disease burden in those with a high mental stress load. Understanding causality is important when developing targeted interventions. We aimed to estimate the effect of mental stress on mortality by performing a 'natural' experiment using spousal bereavement as a disease-independent mental stressor.

Methods: We followed a population-based matched cohort, including all individuals in Denmark bereaved in 1997-2014, for 17 years. Prospectively recorded register data were obtained for civil and vital status, 39 mental and physical diagnoses, and socioeconomic factors.

Results: In total, 389 316 bereaved individuals were identified and 137 247 died during follow-up. Bereaved individuals had higher all-cause mortality than non-bereaved references in the entire study period. The relative mortality in the bereaved individuals was highest shortly after the loss (adjusted hazard ratio (aHR), first month: 2.50, 95% confidence interval (CI) 2.37-2.63; aHR, 6-12 months: 1.38, 95% CI 1.34-1.42). The excess mortality rate associated with bereavement rose with increasing number of physical diseases (1.33 v. 7.00 excess death per 1000 person-months for individuals with 0 v. ⩾3 physical conditions during the first month) and was exacerbated by the presence of mental illness. The excess mortality among bereaved individuals was primarily due to death from natural causes.

Conclusions: Bereavement was associated with increased short-term and long-term mortality, even after adjustment for morbidities, which suggests that mental stress may play a causal role in excess mortality.

Keywords: Bereavement; comorbidity; epidemiology; mental health; mortality; multimorbidity; psychological; stress; widowhood.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Bereavement*
  • Cause of Death
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mortality*
  • Multimorbidity
  • Proportional Hazards Models
  • Registries
  • Sex Distribution
  • Stress, Psychological / epidemiology*
  • Time Factors
  • Young Adult