Comprehensive Meta-Analysis of Excess Mortality in Depression in the General Community Versus Patients With Specific Illnesses
Comprehensive Meta-Analysis of Excess Mortality in Depression in the General Community Versus Patients With Specific Illnesses
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DOI：
10.1176/appi.ajp.2013.13030325
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发表时间：
2014-04-01
影响因子：
17.7
通讯作者：
Penninx, Brenda W.
中科院分区：
文献类型：
--
作者：
Cuijpers, Pim;Vogelzangs, Nicole;Penninx, Brenda W.
目的：数百项研究表明，抑郁症与随访时死亡风险增加有关。然而，目前尚不清楚这种关联的机制是疾病特异性的，导致特定患者群体的死亡率较高，还是通用的，导致所有患者群体以及社区样本的死亡率相当。作者进行了一项全面的荟萃分析的前瞻性研究的社区以及患者样本相关联的抑郁症在基线与额外的死亡率在follow-up.Method：作者进行了系统的检索PubMed，PsycINFO，和Embase。如果抑郁症是用标准化的工具测量的，死亡率被报告为抑郁症和非抑郁症参与者在follow-up.Results：共有293项研究，包括来自35个国家的1，813，733名参与者（135，007抑郁症和1，678，726非抑郁症）。与非抑郁受试者相比，抑郁受试者的总体未校正死亡相对风险为1.64（95%CI =1.56-1.76），异质性较高（I-2=83，95%CI =80-84）。校正发表偏倚后，总体相对风险降至1.52（95% CI =1.45-1.59）。在相对健康的社区样本和患有心脏病、癌症、肾病或其他疾病的特定患者样本中，没有发现合并相对风险不同的强有力的迹象，除了慢性阻塞性肺疾病患者的风险显著更高（p
Objective: Several hundred studies have shown that depression is associated with an elevated risk of dying at follow-up. It is not clear, however, whether the mechanisms for this association are disease specific, leading to higher mortality in specific patient groups, or generic, resulting in comparable mortality rates in all patient groups as well as in community samples. The authors conducted a comprehensive meta-analysis of prospective studies of community as well as patient samples associating depression at baseline with excess mortality at follow-up.Method: The authors conducted systematic searches of PubMed, PsycINFO, and Embase. Studies were included if depression was measured with a standardized instrument and mortality was reported for both depressed and nondepressed participants at follow-up.Results: A total of 293 studies including 1,813,733 participants (135,007 depressed and 1,678,726 nondepressed) from 35 countries were included. The overall unadjusted relative risk of mortality in depressed relative to nondepressed participants was 1.64 (95% Cl=1.56-1.76), with high heterogeneity (I-2=83, 95% Cl=80-84). After adjustment for publication bias, the overall relative risk was reduced to 1.52 (95% Cl=1.45-1.59). No strong indications were found that the pooled relative risk was different across the relatively healthy community samples and specific patient samples with heart disease, cancer, kidney disease, or other disease, except for a significantly higher risk in patients with chronic obstructive pulmonary disease (p