The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses
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...
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| Published in: | BMC medicine Vol. 16; no. 1; pp. 112 - 13 |
|---|---|
| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
London
BioMed Central
20.07.2018
BioMed Central Ltd Springer Nature B.V BMC |
| Subjects: | |
| ISSN: | 1741-7015, 1741-7015 |
| Online Access: | Get full text |
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| 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. |
|---|---|
| AbstractList | 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. [...]we used credibility ceilings, which is a method of sensitivity analyses to account for potential methodological limitations of observational studies that might lead to spurious precision of combined effect estimates. Furthermore, when only studies that provided adjusted estimates were considered, associations of depression and all-cause mortality in cancer and post-acute myocardial infarction dropped to suggestive evidence. [...]the association of depression and all-cause mortality in cancer was supported by suggestive evidence only when studies that adjusted at least for age and sex were assessed in analysis. [...]a recent study pooled evidence from 15 systematic reviews and meta-analyses and observed that evidence that depression is associated with all-cause mortality remains inconclusive [84]. [...]the Ioannidis test has relatively low power in a context of high heterogeneity [42], while the assumption that the largest study could approximate the underlying ‘true’ effect size of a meta-analysis may be less straightforward for observational studies than for randomized controlled trials. 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.BACKGROUNDDepression 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.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.METHODSWe 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.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.RESULTSA 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.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.CONCLUSIONSEven 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. 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. 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. 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. 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. 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. |
| ArticleNumber | 112 |
| Audience | Academic |
| Author | Machado, Myrela O. Schuch, Felipe B. Carvalho, André F. Stubbs, Brendon Sanches, Marcos Ioannidis, John P. A. Thompson, Trevor Koyanagi, Ai Fava, Giovanni A. Tzoulaki, Ioanna Veronese, Nicola Vancampfort, Davy Maes, Michael Solmi, Marco |
| Author_xml | – sequence: 1 givenname: Myrela O. surname: Machado fullname: Machado, Myrela O. organization: Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará – sequence: 2 givenname: Nicola surname: Veronese fullname: Veronese, Nicola organization: Institute for Clinical Research and Education in Medicine (IREM), National Research Council, Neuroscience Institute, Aging Branch – sequence: 3 givenname: Marcos surname: Sanches fullname: Sanches, Marcos organization: Biostatistical Consulting Unit, Centre for Addiction and Mental Health (CAMH) – sequence: 4 givenname: Brendon surname: Stubbs fullname: Stubbs, Brendon organization: Institute for Clinical Research and Education in Medicine (IREM), South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Faculty of Health, Social Care and Education, Anglia Ruskin University – sequence: 5 givenname: Ai surname: Koyanagi fullname: Koyanagi, Ai organization: Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu/CIBERSAM – sequence: 6 givenname: Trevor surname: Thompson fullname: Thompson, Trevor organization: Faculty of Education and Health, University of Greenwich – sequence: 7 givenname: Ioanna surname: Tzoulaki fullname: Tzoulaki, Ioanna organization: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, MRC-PHE Centre for Environment, School of Public Health, Imperial College London, Department of Hygiene and Epidemiology, University of Ioannina Medical School – sequence: 8 givenname: Marco surname: Solmi fullname: Solmi, Marco organization: Institute for Clinical Research and Education in Medicine (IREM), Department of Neuroscience, University of Padova – sequence: 9 givenname: Davy surname: Vancampfort fullname: Vancampfort, Davy organization: Department of Rehabilitation Sciences, KU Leuven - University of Leuven, KU Leuven - University of Leuven, University Psychiatric Center KU Leuven – sequence: 10 givenname: Felipe B. surname: Schuch fullname: Schuch, Felipe B. organization: Centro Universitário La Salle, Hospital de Clínicas de Porto Alegre – sequence: 11 givenname: Michael surname: Maes fullname: Maes, Michael organization: Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, IMPACT Strategic Research Center, Barwon Health, Deakin University – sequence: 12 givenname: Giovanni A. surname: Fava fullname: Fava, Giovanni A. organization: Department of Psychology, University of Bologna, Department of Psychiatry, Erie County Medical Center – sequence: 13 givenname: John P. A. surname: Ioannidis fullname: Ioannidis, John P. A. organization: Department of Medicine, Stanford University, Department of Health Research and Policy, Stanford University, Department of Statistics, Stanford University, Department of Meta-Research Innovation Center at Stanford (METRICS), Stanford University – sequence: 14 givenname: André F. surname: Carvalho fullname: Carvalho, André F. email: andre.carvalho@camh.ca, andrefc7@hotmail.com organization: Department of Psychiatry, University of Toronto, Centre for Addiction & Mental Health (CAMH) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30025524$$D View this record in MEDLINE/PubMed |
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Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has suggested... Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has suggested that... [...]we used credibility ceilings, which is a method of sensitivity analyses to account for potential methodological limitations of observational studies that... Abstract Background Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has... |
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| SubjectTerms | All-cause Analysis Anxiety Biomedicine Cancer Cardiovascular disease Care and treatment Cause of Death - trends Cause-specific Depression Depression - mortality Depression - pathology Depression, Mental Diagnosis Evidence-based medicine Humans Medicine Medicine & Public Health Mental depression Mental disorders Meta-analyses Meta-analysis Meta-Analysis as Topic Mortality Myocardial infarction Observational Studies as Topic Research Article Risk factors Sensitivity analysis Survival Rate Systematic review Systematic reviews Systematic Reviews as Topic |
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| Title | The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses |
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