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

Machado, Myrela O., Veronese, Nicola, Sanches, Marcos, Stubbs, Brendon, Koyanagi, Ai, Thompson, Trevor, Tzoulaki, Ioanna, Solmi, Marco, Vancampfort, Davy, Schuch, Felipe B., Maes, Michael, Fava, Giovanni A., Ioannidis, John P. A. and Carvalho, Andre F. (2018) The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses. BMC Medicine, 16 (1). p. 112. ISSN 1741-7015

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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.

Item Type: Journal Article
Keywords: Depression, Mortality, All-cause, Cause-specific, Systematic reviews, Meta-analyses, Survival, Umbrella review, Psychiatry, Environmental risk factors, Acute coronary syndrome, Severe mental illness, Excess mortality, Prognostic association, Myocardial infarction, Cardiovascular events, Heart failure, Credibility ceilings, Unipolar depression
Faculty: ARCHIVED Faculty of Health, Social Care & Education (until September 2018)
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 04 Jun 2020 10:15
Last Modified: 09 Sep 2021 18:56

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