The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses.
Por:
Machado MO, Veronese N, Sanches M, Stubbs B, Koyanagi A, Thompson T, Tzoulaki I, Solmi M, Vancampfort D, Schuch FB, Maes M, Fava GA, Ioannidis JPA and Carvalho AF
Publicada:
20 jul 2018
Ahead of Print:
20 jul 2018
Categoría:
Medicine (miscellaneous)
Resumen:
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.
Filiaciones:
Machado MO:
Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, 60430-140, Brazil
Veronese N:
Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
National Research Council, Neuroscience Institute, Aging Branch, 35128, Padova, Italy
Sanches M:
Biostatistical Consulting Unit, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
Stubbs B:
Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, AF, SE5 8, UK
Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK
Koyanagi A:
Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu/CIBERSAM, 08950, Barcelona, Spain
Thompson T:
Faculty of Education and Health, University of Greenwich, London, SE10 9LS, UK
Tzoulaki I:
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, London, UK
MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, W2 1PG, UK
Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
Solmi M:
Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
Department of Neuroscience, University of Padova, 35100, Padova, Italy
Vancampfort D:
Department of Rehabilitation Sciences, KU Leuven - University of Leuven, 3001, Leuven, Belgium
KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, 3070, Leuven, Kortenberg, Belgium
Schuch FB:
Centro Universitário La Salle, Canoas, Brazil
Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
Maes M:
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
IMPACT Strategic Research Center, Barwon Health, Deakin University, Geelong, VIC, Australia
Fava GA:
Department of Psychology, University of Bologna, viale Berti Pichat 5, 40127, Bologna, Italy
Department of Psychiatry, Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA
Ioannidis JPA:
Department of Medicine, Stanford University, Palo Alto, CA, 94305, USA
Department of Health Research and Policy, Stanford University, Palo Alto, CA, 94305, USA
Department of Statistics, Stanford University, Palo Alto, CA, 94305, USA
Department of Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, 94305, USA
Carvalho AF:
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Centre for Addiction Mental Health (CAMH), 33 Russel Street, room RS1050S, Toronto, ON, M5S 2S1, Canada.
Green Published, Green Accepted, gold
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