The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses

BMC Medicine

Marcos Sanches¹  Felipe B. Schuch²  Myrela O. Machado³  Ioanna Tzoulaki⁴  John P. A. Ioannidis⁵  Michael Maes⁶  André F. Carvalho⁷  Giovanni A. Fava⁸  Davy Vancampfort⁹  Trevor Thompson^1,10  Marco Solmi^1,11  Nicola Veronese^1,11  Brendon Stubbs^1,11  Ai Koyanagi^1,12 

[1] Biostatistical Consulting Unit, Centre for Addiction and Mental Health (CAMH);Centro Universitário La Salle;Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará;Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London;Department of Medicine, Stanford University;Department of Psychiatry, Faculty of Medicine, Chulalongkorn University;Department of Psychiatry, University of Toronto;Department of Psychology, University of Bologna;Department of Rehabilitation Sciences, KU Leuven - University of Leuven;Faculty of Education and Health, University of Greenwich;Institute for Clinical Research and Education in Medicine (IREM);Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu/CIBERSAM;

关键词: Depression;    Mortality;    All-cause;    Cause-specific;    Systematic reviews;    Meta-analyses;   

DOI  :  10.1186/s12916-018-1101-z

来源: DOAJ

【 摘 要 】

Abstract Background Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has suggested that depression could be associated with excess all-cause mortality across different settings and populations, although the causality of these associations remains unclear. Methods We conducted an umbrella review of systematic reviews and meta-analyses of observational studies. PubMed, PsycINFO, and Embase electronic databases were searched through January 20, 2018. Systematic reviews and meta-analyses that investigated associations of depression and all-cause and cause-specific mortality were selected for the review. The evidence was graded as convincing, highly suggestive, suggestive, or weak based on quantitative criteria that included an assessment of heterogeneity, 95% prediction intervals, small-study effects, and excess significance bias. Results A total of 26 references providing 2 systematic reviews and data for 17 meta-analytic estimates met inclusion criteria (19 of them on all-cause mortality); data from 246 unique studies (N = 3,825,380) were synthesized. All 17 associations had P < 0.05 per random effects summary effects, but none of them met criteria for convincing evidence. Associations of depression and all-cause mortality in patients after acute myocardial infarction, in individuals with heart failure, in cancer patients as well as in samples from mixed settings met criteria for highly suggestive evidence. However, none of the associations remained supported by highly suggestive evidence in sensitivity analyses that considered studies employing structured diagnostic interviews. In addition, associations of depression and all-cause mortality in cancer and post-acute myocardial infarction samples were supported only by suggestive evidence when studies that tried to adjust for potential confounders were considered. Conclusions Even though associations between depression and mortality have nominally significant results in all assessed settings and populations, the evidence becomes weaker when focusing on studies that used structured interviews and those that tried to adjust for potential confounders. A causal effect of depression on all-cause and cause-specific mortality remains unproven, and thus interventions targeting depression are not expected to result in lower mortality rates at least based on current evidence from observational studies.

【 授权许可】

Unknown