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Depression Linked With Increased Risk of Death, Cardiovascular Events Worldwide

June 16, 2020

Across the world and especially in urban areas, depressive symptoms are associated with an increased risk of mortality and incident cardiovascular disease in adults, according to a large, population-based cohort study. Results were published online in JAMA Psychiatry.

“Our initial question was whether previous research identifying similar patterns of association in mostly Western countries could be generalized to other parts of the world,” an international team of researchers wrote. “Our findings suggest that they can, and we obtained similar results in countries at all economic levels.” 

The study spanned 21 countries, 5 continents, and 145,862 adults aged 35 to 70. Among participants, 11% reported 4 or more depressive symptoms at baseline. The median follow-up was 9.3 years. 

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Adults with 4 or more depressive symptoms, researchers reported, had a 17% increased risk of all-cause mortality and a 14% increased risk of incident cardiovascular disease. Risks increased progressively with the number of depressive symptoms, according to the study.

The relative risks of death and cardiovascular disease were more than twice as high in urban areas than in rural areas, researchers found. Although depressive symptoms were less common in men, associations between depression and death and cardiovascular disease were twice as strong in men compared with women.

“If governments are to achieve the health-related Sustainable Development Goals, especially in resource-poor settings, they should raise awareness of the physical health risks associated with depression and prioritize an integrated and comprehensive approach to tackling noncommunicable diseases and mental disorders,” researchers advised.

“Meanwhile, broader public policies should promote mental well-being and healthy behaviors as part of a comprehensive strategy to control noncommunicable diseases.”

—Jolynn Tumolo


Rajan S, McKee M, Rangarajan S, et al. Association of symptoms of depression with cardiovascular disease and mortality in low-, middle-, and high-income countries. JAMA Psychiatry. 2020 June 10;[Epub ahead of print].

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