A systematic review of the mortality of depression

Objective:The literature on the mortality of depression was assessed with r espect to five issues: 1) strength of evidence for increased mortality, 2) controlling for mediating factors, 3) the contribution of suicide, 4) varia tion across sample types, and 5) possible mechanisms. Method: All relevant English language databases from 1966 to 1996 were searched for reviews and studies that included 1) a formal assessment of depressive symptoms or diso rders, 2) death rates or risks, and 3) an appropriate comparison group. Res ults: There were 57 studies found; 29 (51%) were positive, 13 (23%) negativ e, and 15 (26%) mixed. Twenty-one studies (37%) ranked among the better stu dies on the strength of evidence scale used in this study, but there are to o few comparable, well-controlled studies to provide a sound estimate of th e mortality risk associated with depression. Only six studios controlled fo r more than one of the four major mediating factors. Suicide accounted for less than 20% of the deaths in psychiatric samples, and less than 1% in med ical and community samples. Depression seems to increase the risk of death by cardiovascular disease, especially in men, but depression does not seem to increase the risk of death by cancer. Variability in methods prevents a more rigorous meta-analysis of risk. Conclusion: The studies linking depres sion to early death are poorly controlled, but they suggest that depression substantially increases the risk of death, especially death by unnatural c auses and cardiovascular disease. Future well-controlled studies of high ri sk groups may guide efforts to develop treatments that reduce the mortality risk of depression.