Anxiety disorders and all-cause mortality: systematic review and meta-analysis

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d1715929e148">Purpose</h5> <p id="P1">The purpose of this study was to perform a systematic review and meta-analysis of prospective cohort studies that examined the relationship between anxiety disorders, or clinically significant anxiety symptoms, at baseline and all-cause mortality at follow-up relative to control participants without clinically significant anxiety. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d1715929e153">Methods</h5> <p id="P2">PubMed, EMBASE, PsycInfo and CINAHL were searched through July 2015, along with manual searches of published reviews and forward and backward snowball searches of included studies. Studies were excluded if anxiety was not defined with a standardized instrument, or if participants were followed up for one year or less. The initial search yielded 7,901 articles after removal of duplicates, of which 328 underwent full-text screening. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d1715929e158">Results</h5> <p id="P3">Forty-two estimates from 36 articles were included in the meta-analysis with a total sample of 127,552 participants and over 11,573 deaths. The overall Hazard Ratio (HR) estimate of mortality in clinically anxious participants relative to controls was 1.09 (95% CI: 1.01–1.16), however this was reduced after adjusting for publication bias (1.03; 95% CI: .95–1.13). There was no evidence of increased mortality risk among anxious participants derived from community samples (0.99; 95% CI: 0.96–1.02) and in studies that adjusted for a diagnosis of depression (1.01; 95% CI: 0.96–1.06). </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d1715929e163">Conclusions</h5> <p id="P4">These findings suggest that positive associations in the literature are attributable to studies in smaller samples, comorbid depression (or other psychiatric conditions) among participants, and possible confounding in medical patient samples followed up for short durations. </p> </div>

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Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

Timothy A Brown, Laura A Campbell, Cassandra L. Lehman … (2001)

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.

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Anxiety and risk of incident coronary heart disease: a meta-analysis.

Annelieke M Roest, Elisabeth J Martens, Peter de Jonge … (2010)

The purpose of this study was to assess the association between anxiety and risk of coronary heart disease (CHD). Less research has focused on the association of anxiety with incident CHD in contrast to other negative emotions, such as depression. A meta-analysis of references derived from PubMed, EMBASE, and PsycINFO (1980 to May 2009) was performed without language restrictions. End points were cardiac death, myocardial infarction (MI), and cardiac events. The authors selected prospective studies of (nonpsychiatric) cohorts of initially healthy persons in which anxiety was assessed at baseline. Twenty studies reporting on incident CHD comprised 249,846 persons with a mean follow-up period of 11.2 years. Anxious persons were at risk of CHD (hazard ratio [HR] random: 1.26; 95% confidence interval [CI]: 1.15 to 1.38; p < 0.0001) and cardiac death (HR: 1.48; 95% CI: 1.14 to 1.92; p = 0.003), independent of demographic variables, biological risk factors, and health behaviors. There was a nonsignificant trend for an association between anxiety and nonfatal MI (HR: 1.43; 95% CI: 0.85 to 2.40; p = 0.180). Subgroup analyses did not show any significant differences regarding study characteristics, with significant associations for different types of anxiety, short- and long-term follow-up, and both men and women. Anxiety seemed to be an independent risk factor for incident CHD and cardiac mortality. Future research should examine the association between anxiety and CHD with valid and reliable anxiety measures and focus on the mechanisms through which anxiety might affect CHD. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses.

Pim Cuijpers, Nicole Vogelzangs, Jos Twisk … (2014)

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.