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 pre­vious 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<0.01) and that internalizing outperforms disorder‐specific variance (e.g., depression‐specific variance) in the prediction of that risk. Further, there was a significant interaction between transdiagnostic internalizing and self‐reported health, whereby internalizing psychopathology had a specific association with early death for individuals with excellent self‐reported health condition (HR=1.50, 95% CI: 1.17‐1.84, p<0.05). This highlights the clinical utility of using the transdiagnostic internalizing factor for prediction of an important future outcome, and supports the argument that internalizing psychopathology can be a meaningful liability to explore in public health practice.

中文翻译：

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内化精神病理学和全因死亡率：跨诊断与基于诊断的风险预测的比较

以前的研究已经记录了跨诊断内化因素在预测重要的未来结果（例如，随后的精神障碍诊断）中的效用。然而，迄今为止，还没有研究调查内化因素是否可以预测死亡风险。此外，虽然之前关于死亡风险的研究强调了它与特定内化障碍的关联，但没有研究评估跨诊断内化因素与疾病特异性方差如何不同地预测该风险。本研究的主要目的是探索：a) 内化因素是否可以预测死亡风险，b) 特定的内化精神病理学是否可以在跨诊断内化因素之外唯一地预测死亡风险，c) 内化与自我报告的健康状况在死亡风险预测中是否存在显着的相互作用。我们利用了来自美国中年 (MIDUS) 的美国成年人的大量全国样本，这是一项纵向研究，检查了 1995 年至 2015 年之间多个波浪中个人的中年发展。分析了完成电话采访的 6,329 名参与者的数据和MIDUS 1 (1995-1996) 中的自填问卷，然后随访至 2015 年 10 月 31 日或直至死亡。为了研究内化风险和死亡风险之间的关联，我们使用了半参数比例风险 Cox 模型，其中生存时间根据潜在内化因素进行回归。总体研究结果表明，跨诊断内化因素可显着预测 20 年期间的死亡风险（风险比，HR=1.12，95% CI：1.05-1.16，p<0.01）并且内化优于疾病特异性方差（例如，抑郁症-特定方差）在该风险的预测中。此外，跨诊断内化和自我报告的健康之间存在显着的相互作用，由此内化精神病理学与自我报告健康状况良好的个体的早逝具有特定关联（HR=1.50，95% CI：1.17-1.84，p< 0.05）。这突出了使用跨诊断内化因子预测重要未来结果的临床效用，