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Comprehensive Meta-Analysis of Excess Mortality in Depression in the General Community Versus Patients With Specific Illnesses

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Cuijpers, Pim, Vogelzangs, Nicole, Twisk, Jos, Kleiboer, Annet, Li, Juan, Penninx, Brenda W.·2014·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2013.13030325

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Abstract

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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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
ORCID: Cuijpers, Pim
Vogelzangs, Nicole
Twisk, Jos
Kleiboer, Annet
Penninx, Brenda W.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2014-04
Volume: 171
Issue: 4
Pages: 453-462
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2013.13030325
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
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: Health Sciences › Medicine › Psychiatry and Mental health › 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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Comprehensive Meta-Analysis of Excess Mortality in Depression in the General Community Versus Patients With Specific Illnesses

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