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

Miloyan, Beyon, Bulley, Adam, Bandeen-Roche, Karen, Eaton, William W. and Goncalves-Bradley, Daniela C. (2016) Anxiety disorders and all-cause mortality: systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 51 11: 1-9. doi:10.1007/s00127-016-1284-6


Author Miloyan, Beyon
Bulley, Adam
Bandeen-Roche, Karen
Eaton, William W.
Goncalves-Bradley, Daniela C.
Title Anxiety disorders and all-cause mortality: systematic review and meta-analysis
Journal name Social Psychiatry and Psychiatric Epidemiology   Check publisher's open access policy
ISSN 0933-7954
1433-9285
Publication date 2016-09-14
Sub-type Article (original research)
DOI 10.1007/s00127-016-1284-6
Open Access Status Not yet assessed
Volume 51
Issue 11
Start page 1
End page 9
Total pages 9
Place of publication Heidelberg, Germany
Publisher Springer Medizin
Language eng
Abstract 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.

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 1 year or less. The initial search yielded 7901 articles after the removal of duplicates, of which 328 underwent full-text screening.

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 0.95-1.13). 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).

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.
Formatted abstract
Purpose: 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.

Methods: 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 1 year or less. The initial search yielded 7901 articles after the removal of duplicates, of which 328 underwent full-text screening.

Results: 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 0.95–1.13). 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).

Conclusions: 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.
Keyword Anxiety
Anxiety disorders
Death
Mortality
Survival
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID T32 AG000247
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Psychology Publications
 
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