Background. Depressive disorders are associated with substantial risk of premature mortality. A number of factors may contribute to reported risk estimates, making it difficult to determine actual risk of excess mortality in community cases of depression. The aim of this study is to conduct a systematic review and meta-analysis of excess mortality in population-based studies of clinically defined depression. Methods. Population-based studies reporting all-cause mortality associated with a clinically defined depressive disorder were included in the systematic review. Estimates of relative risk for excess mortality in population-representative cases of clinical depressive disorders were extracted. A meta-analysis was conducted using Stata to pool estimates of excess mortality and identify sources of heterogeneity within the data. Results. Twenty-one studies reporting risk of excess mortality in clinical depression were identified. A significantly higher risk of mortality was found for major depression (RR 1.92 95% CI 1.65–2.23), but no significant difference was found for dysthymia (RR 1.37 95% CI 0.93–2.00). Relative risk of excess mortality was not significantly different following the adjustment of reported risk estimates. Conclusion. A mortality gradient was identified with increasing severity of clinical depression. Recognition of depressive symptoms in general practice and appropriate referral for evidence-based treatment may help improve outcomes, particularly in patients with comorbid physical disorders. 1. Introduction Depressive disorders make a substantial contribution to the global burden of disease [1–3]. Their contribution to disease burden is largely attributed to the high prevalence of, and disability caused by, depression . Contribution to disease burden of premature mortality in individuals with depression is less well studied, with the exception of suicide and more recently coronary heart disease. Depressive disorders are a well-recognized risk factor for suicide , and increased treatment of depression has been associated with a decrease in suicide rates [5, 6]. Increased risk of excess all-cause mortality has previously been shown in psychiatric inpatients [7–9]. Excess mortality in psychiatric inpatients has been associated with conditions such as gastrointestinal infection and respiratory disease, and previously attributed to conditions within hospitals or asylums , although the introduction of modern psychiatric treatments and shorter duration of stay in hospitals has improved mortality outcomes for individuals
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