抑郁症是一种普遍和致残的精神障碍,经常与多种慢性疾病同时发生。有证据表明,抑郁症可能与不同环境和人群的全因死亡率过高有关,尽管这些关联的因果关系尚不清楚.
我们对观察性研究的系统评价和荟萃分析进行了综述。PubMed,PsycINFO,和Embase电子数据库在2018年1月20日进行了搜索。选择了系统评价和荟萃分析,以调查抑郁症与全因和特定于原因的死亡率之间的关系。证据被评为令人信服,高度暗示性,暗示,或基于包括异质性评估在内的定量标准较弱,95%的预测间隔,小型研究效果,和过度显著性偏差。
共有26篇参考文献提供了2篇系统评价,17篇荟萃分析估计数据符合纳入标准(其中19篇涉及全因死亡率);综合了来自246项独特研究(N=3,825,380)的数据。所有17个协会的随机效应汇总效应P<0.05,但他们都不符合令人信服的证据标准.急性心肌梗死后患者抑郁和全因死亡率的关系,在心力衰竭患者中,在癌症患者以及来自混合环境的样本中,均符合高暗示性证据的标准.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,没有任何关联得到高度暗示性证据的支持.此外,在考虑了试图对潜在混杂因素进行校正的研究时,仅有提示性证据支持癌症和急性心肌梗死后样本中抑郁和全因死亡率的关联.
尽管抑郁症和死亡率之间的关联在所有评估的环境和人群中都有名义上显著的结果,当专注于使用结构化访谈的研究和试图调整潜在混杂因素的研究时,证据变得较弱。抑郁症对全因死亡率和特定原因死亡率的因果影响仍未得到证实,因此,至少根据目前观察性研究的证据,针对抑郁症的干预措施预计不会降低死亡率.
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.