Anxiety and life-course mortality.

Lead Research Organisation: King's College London
Department Name: Psychological Medicine

Abstract

Anxiety is an unpleasant and common problem and many people attend their doctors asking for help. There are very effective medicines for reducing anxiety, but in humans and animals anxiety seems to involve noticing and escaping from danger so may be a useful characteristic.

I have already completed a study which showed that the less anxious half of a large group of British school children suffered many more accidents and fatal accidents in their young adult lives than the more anxious half of the group. This is the first scientific work showing that anxiety is useful for people.

I plan to follow on from this work, looking at different, larger groups of people from different countries, whose anxiety was measured in different ways at different stages in their lives. I hope to find out more about the some of the useful and harmful things about anxiety, working towards a better understanding so that in the future doctors can be confident that when they reduce someone‘s anxiety with medicines they know they are really helping rather than harming that person.

Technical Summary

Aims & Objectives:
To replicate the finding that high trait anxiety reduces risk of fatal accidents in young adult life.
To establish whether this effect is large enough to affect all-cause mortality.
To investigate this further by establishing if there is dose-response effect.
To establish whether chronic ‘case level anxiety‘ (anxiety disorder) represents a harmful or a protective level of anxiety in terms of mortality.
To determine whether this effect is the same in different settings and time periods.
To investigate causal pathways from low trait anxiety to increased accidents, especially use of alcohol.
Design & Methodology: Five longitudinal cohort studies will be used: the Swedish Twin Register, the Norwegian Nord-Trøndelag Health Study, the British National Child Development Study, the British Cohort Study and the British Health and Lifestyle Survey. These surveys have a total of 127,723 participants, born between 1928 and 1970, who have been followed up for between 4 and 26 years. The primary analyses will be survival analyses using Cox‘s Proportional Hazards Model. The exposures will be measures of neuroticism/trait anxiety from each of the sources of data. Results will be corrected for likely confounders and investigations of causal pathways will be undertaken, especially alcohol use.
Scientific & Medical Opportunities: Robust evidence connects high trait anxiety/neuroticism with poor outcomes. An evolutionary understanding predicts beneficial effects too. I hope to broaden the understanding of this concept by determining and evaluating these benefits.

Publications

10 25 50
 
Description Bicycle mortality trends.
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description BioBank
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
Impact I sit on the panel which sets the mental health questions for UK Biobank
 
Description GMC - End of life care.
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact The guidance will be published in May 2010. It will be GMC ethical guidance.
 
Description Liaison NHS England
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
Impact In part due to the liaison psychiatry staffing surveys which I lead, the gov released £373m to spend on new liaison psychiatry services. I sit on the panel which distributes these monies.
 
Description Liaison Pain Consultation
Geographic Reach National 
Policy Influence Type Participation in advisory committee
Impact The Pain Relief Society is leading a large consultation over clinical guidance for the treatment of Complex Regional Pain Syndrome. I led the consultation from the Liaison Faculty of the Royal College of Psychiatrists. We made numerous suggestions, large and small, including that the syndrome should be renamed.
 
Description Neuroleptic Malignant Syndrome Guidance
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact I led/wrote the Royal College's answer to a coroner's request for a joint statement from the Royal College of Psychiatrists and the Royal College of Physicians about the optimal management of neuroleptic malignant syndrome.
URL https://www.rcpsych.ac.uk/pdf/PS03_2014.pdf
 
Description Safe staffing
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact I led the Liaison Faculty and Royal College of Psychiatrists response to the NICE consultation about safe nursing staffing levels in Emergency Departments.
 
Description Strobe
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
URL http://www.strobe-statement.org
 
Description Cognitive Impairment PhD
Amount £60,000 (GBP)
Organisation University of Plymouth 
Sector Academic/University
Country United Kingdom
Start 09/2018 
End 08/2021
 
Description Dementia epidemilogy
Amount £30,000 (GBP)
Organisation UK Space Agency 
Sector Public
Country United Kingdom
Start 03/2018 
End 10/2018
 
Description PHE
Amount £52,628 (GBP)
Organisation Public Health England 
Sector Public
Country United Kingdom
Start 01/2016 
End 01/2017
 
Description Procurement of HEE surveying.
Amount £110,000 (GBP)
Organisation Health Education England 
Sector Public
Country Unknown
Start 04/2015 
End 11/2016
 
Title SHIELD > BRC 
Description This was the creation of unique datalink between King's, St Thomas's and the Maudsley examine self harm presentations. 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact One paper, one poster, one poster prize, one proof of concept of focused, project based merges. 
URL http://bjpo.rcpsych.org/content/2/3/217.full-text.pdf
 
Title TCR 
Description This is a database link between St Christopher's Hospice and the Thames Cancer Registry. It allowed, for the first time, the accessibility of Palliative Care Services to be assessed. 
Type Of Material Biological samples 
Provided To Others? No  
Impact There has been a poster and the resulting paper is published in Palliative Medicine. 
 
Description ACONF 
Organisation University of Aberdeen
Department Academic Child Health
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Had a research idea which the dataset could test.
Collaborator Contribution Allowed and facilitated the dataset to answer the question.
Impact One MSc thesis. Papers to be published before Oct 2014.
Start Year 2007
 
Description BCS70 
Organisation University College London
Department Institute of Epidemiology and Health Care
Country United Kingdom 
Sector Academic/University 
PI Contribution I am providing the manpower and expertise to do the survival analyses.
Collaborator Contribution Providing data and expertise to carry out the main analysis on data from the 1970 birth cohort datasets.
Impact None.
Start Year 2010
 
Description HUNT 
Organisation University of Bergen
Department Faculty of Psychology
Country Norway 
Sector Academic/University 
PI Contribution I brought expertise in survival analyses, and the resources to carry out the analysis of trait anxiety and mortality.
Collaborator Contribution This department holds the data for part of the main project to examine trait anxiety and mortality. They also have extensive expertise in the use of this particular dataset, the HUNT study.
Impact Presentation at UK Liaison Psychiatry conference in Cardiff, UK, 2010. Presentation at the 3rd European Public Health Conference, Amsterdam, Netherlands, 2010. Disciplines include Psychiatry, Psychology, Epidemiology and Statistics. Two papers in prep.
Start Year 2009
 
Description Hannover 
Organisation Hannover Medical School
Department Twincore
Country Germany 
Sector Academic/University 
PI Contribution I provided the expertise to interpret the initial finding and advised on further analyses which made the findings interpretable.
Collaborator Contribution Felix Wedegärtner has provided the data for a sub-project analysis looking at health insurance data of diagnosis with anxiety problems against early retirement and mortality.
Impact Submission of abstract to World Psychiatric Association Hawaii, 2011. (rejected) Submission of abstract to European Psychiatric Association Vienna, 2011. (accepted) Paper in prep.
Start Year 2010
 
Description LSHTM 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Department Department of Non-communicable Disease Epidemiology
Country United Kingdom 
Sector Academic/University 
PI Contribution Had idea which, once honed, was able to be tested by the ACONF.
Collaborator Contribution Allowed, supported and facilitated data use.
Impact One MSc thesis. Papers will be published before Oct 2014.
Start Year 2007
 
Description MRC NSHD 
Organisation University College London
Department Institute of Epidemiology and Health Care
Country United Kingdom 
Sector Academic/University 
PI Contribution We had the idea for the work. UCL MRC NSHD have the data, advised on the analysis and assisted with the drafting of the paper.
Collaborator Contribution They have the dataset for part of our study.
Impact 16393365, 21181112, plus another one in resubmission at the moment.
Start Year 2007
 
Description NCCMH / HEE / NHSE 
Organisation Royal College of Psychiatrists
Country United Kingdom 
Sector Learned Society 
PI Contribution Created to survey Liaison Psychiatry in England
Collaborator Contribution Undertook three annual surveys of Liaison Psychiatry and one of Liaison Psychology.
Impact Two reports from the second and third survey.
Start Year 2013
 
Description NCDS 
Organisation University College London
Department Institute of Epidemiology and Health Care
Country United Kingdom 
Sector Academic/University 
PI Contribution I am providing the manpower and expertise for the survival analyses for the main project looking at trait anxiety and mortality.
Collaborator Contribution Provided data and expertise for the 1958 birth cohort study analysis for the main project.
Impact I now have the data for this analysis. Paper in prep.
Start Year 2009
 
Description PenCLARC 
Organisation National Institute for Health Research
Department NIHR CLAHRC South West Peninsula
Country United Kingdom 
Sector Public 
PI Contribution I bring data oversight and skills, plus psychiatric experience.
Collaborator Contribution IAPT dataset
Impact 3 IAPT papers. 1 published in 2017, one submitted and one in prep.
Start Year 2013
 
Description Ristvedt 
Organisation University of Washington
Department Department of Psychiatry and Behavioral Sciences
Country United States 
Sector Academic/University 
PI Contribution I provide the expertise and access to data for the gender-interaction hypothesis to be tested.
Collaborator Contribution Dr Stephen Ristvedt contacted me about my publication in psychological medicine in 2006 asking if there was an interaction by sex. There was a suggestion of an interaction which tied up with his work, but the numbers were too small for publication. He and I are planning to replicate this work in the larger datasets which are now available to me.
Impact None.
Start Year 2008
 
Description Swedish Twins 
Organisation Karolinska Institute
Department Swedish Twin Registry
Country Sweden 
Sector Academic/University 
PI Contribution Provided a research idea which the dataset could test.
Collaborator Contribution Allowed and facilitated data access.
Impact One PhD thesis. Papers to be published before Oct 2014.
Start Year 2007
 
Description Thames Cancer Registry 
Organisation King's College London
Department School of Medicine KCL
Country United Kingdom 
Sector Academic/University 
PI Contribution I conceived the study to examine the penetrance of palliative care in the community by comparing Hospice rolls with cancer deaths in the catchment as collected by the Cancer Registry.
Collaborator Contribution Dataset and setting for merges as well as partial-data match-merge expertise.
Impact Paper: Coupland, V.H., Lee, W., Madden, P., Sykes, N., Heal, R., Møller, H., Davies, E.A., Is it possible to determine use of hospice palliative care services by matching hospice and cancer registry data?, Palliative Medicine 2010 DOI: 10.1177/0269216310377815 Poster: Coupland, V., Lee, W., Madden, P., Møller, H., Davies, E., Are cancer patients receiving palliative care from a large South London Hospice more affluent than those not accessing its services?, at COMPASS Collaborative Conference 2008: Edinburgh, UK. Poster: Coupland, V., Lee, W., Madden, P., Møller, H., Davies, E., Are cancer patients receiving palliative care from a large South London Hospice more affluent than those not accessing its services? at UKACR Conference 2008: Oxford, UK.
Start Year 2008
 
Description BBC Radio 4 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact I was interviewed on the BBC Radio 4 programme 'The Material World' to discuss the poor reporting of nutrition stories in the UK print media.

Numerous requests to write articles (one just submitted to a trade journal for dieticians). Much hostility from journalists, much of which demonstrated the size of the problem. (look in the comments, which include some by science correspondents os Daily Mail, Independent. Critical article by Science editor of Guardian.
1) http://www.guardian.co.uk/commentisfree/2011/jun/17/bad-science-health-reporting
2) http://www.guardian.co.uk/science/2011/jul/04/ben-goldacre-study-dietary-news
3) http://www.guardian.co.uk/science/2011/jul/05/dietary-health-claims-ben-goldacre
Year(s) Of Engagement Activity 2011
URL http://www.guardian.co.uk/science/2011/jul/05/dietary-health-claims-ben-goldacre
 
Description BBC World Service 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact The science show 'Discovery' came to the Institute of Psychiatry to attend Journal Club (which I run). The show was about keeping the libel laws out of science. I was interviewed because I run the Journal Club and because I wrote the critical appraisal chapter in one of the standard text books for junior psychiatrists.

One hopes we contributed to libel reform momentum.
Year(s) Of Engagement Activity 2010
 
Description Chapter - Palliative Care Nursing 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Health professionals
Results and Impact I wrote a chapter for the course text Palliative Care Nursing.

This book is a standard text for Nurses preparing to work in Palliative Care.
Year(s) Of Engagement Activity 2007
 
Description Houses of Parliament 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact A number of Members of Parliament and Ministers attended a meeting of the All-Party Road Safety Group in the Grand Committee Room in the Houses of Parliament. We presented the bicycle mortality work.

We had an influence on the publicity material produced by the charity RoadPeace, an dhad many assurances fro politicians that they take these issues seriously.
Year(s) Of Engagement Activity 2009
 
Description Judging of critical appraisal competition 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Undergraduate students
Results and Impact 137 medical and nursing students entered the critical appraisal competition organised by HealthWatch. I sat on the panel of judges. Each judge marked all the entries.

The number of entries to this competition continues to rise.
Year(s) Of Engagement Activity 2012
 
Description Medical student conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Talk "death by design" about assisted dying and execution.
Year(s) Of Engagement Activity 2017
 
Description Pod Delusion / Resonance FM appearance 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Appearance on the Pod Delusion podcast broadcast on Resonance FM.
Year(s) Of Engagement Activity 2012
URL http://t.co/KogltPnK
 
Description PsychSoc talk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact 44 medical students came to hear me talk about 'does anxiety keep you safer?'
Year(s) Of Engagement Activity 2016
 
Description RSM Conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Health professionals
Results and Impact I organised and hosted a conference on Mental Illness and Mortality (directly related to the subject of this project)

I have been asked to write a chapter about medical care in psychiatric populations. Also two additional collaborations came about.
Year(s) Of Engagement Activity 2009
 
Description Utility of Anxiety Talk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Health professionals
Results and Impact I gave a talk to the St Thomas' Hospital Liaison Psychiatry team about my work.

This has attracted at least one Liaison Psychiatrist to academic work.
Year(s) Of Engagement Activity 2009
 
Description Y1's talk about psychiatry 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Talk to Y1 medical students about the basics of psychiatry.
Year(s) Of Engagement Activity 2017