Current issues of ACP Journal Club are published in Annals of Internal Medicine


Life events were associated with mortality in middle-aged men

ACP J Club. 1994 Mar-April;120:44. doi:10.7326/ACPJC-1994-120-2-044

Source Citation

Rosengren A, Orth-Gomer K, Wedel H, Wilhelmsen L. Stressful life events, social support, and mortality in men born in 1933. BMJ. 1993 Oct 30;307:1102-5.



To determine the association between life events and mortality in middle-aged men.


Cohort analytic study of 7 years' duration.


A community in Sweden.


A random sample of half of the men born in Gothenburg in 1933 (n = 1016) were invited to participate. 752 men (age 50 y) completed the questionnaires.

Assessment of risk factors

Physical and laboratory investigations were done; participants completed questionnaires on smoking habits, physical activity, psychological stress, life events, social support, activities during the previous year, self-perceived health, household size, and occupation. Life events were illness or concern about death of a family member, divorce or separation, being forced to move household or change jobs, feeling insecure at work or becoming unemployed, serious financial trouble, and being legally prosecuted.

Main outcome measures

All-cause mortality during the 7 years of follow-up.

Main results

Life events in the year before baseline examination were associated with mortality. Of the men who had ≥ 3 life events (n = 101), 10.9% died compared with 3.3% of the men who had no life events (odds ratio [OR] 3.6, 95% CI 1.5 to 8.5). Specific life events associated with death were concern about a family member (OR 2.3, CI 1.1 to 4.8), moving household (OR 3.3, CI 1.1 to 10.1), feelings of insecurity at work (OR 2.4, CI 1.2 to 5.0), financial problems (OR 3.0, CI 1.3 to 7.3), and being legally prosecuted (OR 7.7, CI 2.6 to 22.7). Social and lifestyle influences on death were smoking (P = 0.005), low occupational class (P = 0.007), low emotional support (P = 0.004), self-perceived poor health (P = 0.001), living alone (P = 0.002), and a low level of activity at home (P = 0.002). After adjusting for smoking, emotional support, and self-perceived health, life events still remained associated with mortality (P = 0.03).


There was an association between life events and mortality among middle-aged men. The association remained after controlling for a number of psychological and social influences.

Sources of funding: Swedish Heart and Lung Foundation; Swedish Council for Social Research; Swedish Labour Market Insurance Company; Swedish Medical Research Council; and Knut and Alice Wallenberg Foundation.

For article reprint: Dr. A. Rosengren, Department of Medicine, Ostra Hospital, S-416 85 Gothenburg, Sweden. FAX 46-31-25-9254.


Western culture has directed physicians, its skillful body technicians, to practice a truncated healing role. This study suggests that society might benefit by asking for a broader conceptualization of disease treatment.

The conclusion of the study by Rosengren and colleagues is generalizable to middle-aged men in Western society. The validity of the results is enhanced by the benefits of a prospective design. Unfortunately, no alcohol data were obtained, making it impossible to discuss the meaning of inevitable interactions between drinking and life events in men.

How might this study influence medicine? Physicians who heed the association between life events and mortality may choose to learn better communication skills in order to enhance biological and psychosocial outcomes (1). Controlled studies have validated the benefits of specific actions pertaining to stress management. For example, survival improves with management of stress after myocardial infarction (2) or with psychosocial treatment of patients with metastatic breast cancer (3). Alcohol screening, "brief interventions," and treatment limit mortality and lower medical costs (4, 5). Depression screening and generalist treatment improve life functioning. Benefits may derive because an action mitigates the effects of life events; alternatively, life events may be prevented by timely assistance that interrupts, for example, alcohol abuse.

Dedicated physicians who treat sickness with modern technology but ignore scientifically validated psychosocial approaches, thus, limit their effectiveness. A balanced approach that upholds traditional healing ideals is an elusive but worthy goal and is supported by this study.

William D. Clark, MD
Mid-Coast HospitalBath, Maine, USA


1. Levinson W, Roter D. The effects of two continuing education programs on communication skills of practicing primary care physicians. J Gen Intern Med. 1993;8:318-24.

2. Frasure-Smith N. In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men. Am J Cardiol. 1991;67:121-7.

3. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 1989;2:888-91.

4. Bein TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: a review. Addiction. 1993;88:315-36.

5. McLellan AT, Grissom GR, Brill P, et al. Private substance abuse treatment effectiveness: are some programs more effective than others? J Subst Abuse Treat. 1993;10:243-54.