Comprehensive Meta-Analysis of Excess Mortality in Depression in the General Community Versus Patients With Specific Illnesses
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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% CI=1.56-1.76), with high heterogeneity (I2=83, 95% CI=80-84). After adjustment for publication bias, the overall relative risk was reduced to 1.52 (95% CI=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<0.05). Also, the relative risk was lower when the follow-up period was longer and when the quality of the study was higher. CONCLUSIONS: The authors could confirm the presence of a significant association between depression and excess mortality, although this association may have been overestimated because of publication bias and low study quality. Few indications were found that this association is stronger in community or specific patient samples.
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Depression is associated with a markedly increased risk of all-cause and cause-specific mortality.
“Moreover, depression associates with a markedly increased risk of all-cause and cause-specific mortality (Cuijpers et al., 2014).”
From Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors (2020) · cites this paper as Cuijpers et al., 2014
Asthma and autoimmune disorders are also increased in severe mental illness, with the risk of osteoporosis being particularly high (OR 2.86).
“Asthma and autoimmune disorders are also increased, 7,8 with the risk of osteoporosis being particularly high (OR 2.86).9”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [8]
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Self-citation
- Authors
- Cuijpers, P., Vogelzangs, N., Twisk, J., Kleiboer, A., Li, J., & Penninx, B. W.
- Affiliations
- Chinese Academy of Sciences (CN)
- Amsterdam Public Health (NL)
- Corresponding author
- Cuijpers, Pim
- Venue
- American Journal of Psychiatry
- Published
- 2014-04
- Volume
- 171
- Issue
- 4
- Pages
- 453-462
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2149984789
- Semantic Scholar
- 19ec33968f9d152c12e1ccab35937e110524bd0f
- Cited by
- 677
- References
- 25
- Citations by year
- 2026: 38 · 2025: 54 · 2024: 49 · 2023: 122 · 2022: 80 · 2021: 64 · 2020: 60 · 2019: 52 · 2018: 53 · 2017: 37 · 2016: 34 · 2015: 22 · 2014: 11 · 2013: 1
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- VU Research Portal (submittedVersion, other-oa)
- Institutional Repository of Institute of Psychology, Chinese Academy of Sciences (Institute of Psychology, Chinese Academy of Sciences) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Multilingual Matters (Channel View Publications) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- depression, excess mortality, mortality risk, community-dwelling adults, disease-specific mortality, chronic obstructive pulmonary disease, heart disease, cancer, kidney disease, publication bias, study quality, follow-up duration
- MeSH terms
- Depressive Disorder, Heart Diseases, Humans, Kidney Diseases, Mortality, Neoplasms, Regression Analysis, Risk, Multivariate Analysis, Case-Control Studies, Pulmonary Disease, Chronic Obstructive
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