The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses.
The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses.
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DOI：
10.1186/s12916-018-1101-z
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发表时间：
2018-07-20
期刊：
影响因子：
9.3
通讯作者：
Carvalho AF
中科院分区：
文献类型：
--
作者：
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;Carvalho AF
抑郁症是一种普遍存在的致残性精神障碍，经常与多种慢性病并存。有证据表明，抑郁症可能与不同环境和人群中过高的全因死亡率有关，尽管这些联系的因果关系尚不清楚。我们对观察性研究的系统性综述和荟萃分析进行了总结性综述。在2018年1月20日之前，对PubMed、CogcINFO和Embase电子数据库进行了搜索。系统综述和荟萃分析被选为综述的对象，这些综述和荟萃分析调查了抑郁症与全因死亡率和特定原因死亡率的关系。根据包括异质性评估、95%预测区间、小规模研究效应和过度显著偏差的量化标准，证据被划分为令人信服的、高度提示的、提示的或弱的。共有26篇文献提供了2篇系统综述和17项荟萃分析估计符合纳入标准的数据(其中19篇关于全因死亡率)；246项独立研究(N = 3,825,380)的数据被综合。所有17个关联的随机效应汇总效应的P & 均为0.05%，但没有一个符合令人信服的证据标准。在急性心肌梗死患者、心力衰竭患者、癌症患者以及混合环境中的样本中，抑郁与全因死亡率之间的相关性符合高度提示性证据的标准。然而，在考虑采用结构化诊断性访谈的研究的敏感性分析中，没有一个关联仍然得到高度暗示的证据的支持。此外，在癌症和急性心肌梗死后的样本中，抑郁症和全原因死亡率之间的关联只有在考虑到试图调整潜在混杂因素的研究时才得到提示性证据的支持。尽管在所有被评估的环境和人群中，抑郁症和死亡率之间的关联在名义上都有显著的结果，但当关注使用结构化访谈的研究，以及那些试图调整潜在混杂因素的研究时，证据就会变得更弱。抑郁症对所有原因和特定原因死亡率的因果影响仍未得到证实，因此，至少根据观察性研究的现有证据，针对抑郁症的干预措施预计不会导致较低的死亡率。本文的在线版本(10.1186/s129160181101-z)包含补充材料，授权用户可以使用。
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. The online version of this article (10.1186/s12916-018-1101-z) contains supplementary material, which is available to authorized users.
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