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

Hyunsik Kim*, Nicholas A. Turiano, Miriam K. Forbes, Roman Kotov, Robert F. Krueger, Nicholas R. Eaton, HiTOP Utility Workgrp

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    27 Citations (Scopus)


    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 pre-vious 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

    Original languageEnglish
    Pages (from-to)276-282
    Number of pages7
    JournalWorld Psychiatry
    Issue number2
    Publication statusPublished - Jun 2021

    Bibliographical note

    Copyright 2021 World Psychiatric Association. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


    • internalizing factor
    • mortality
    • transdiagnostic prediction
    • diagnosis-based prediction
    • major depressive disorder
    • generalized anxiety disorder
    • panic disorder
    • neuroticism
    • Internalizing factor
    • generalized anx­iety disorder


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