Depression and cause-specific mortality in an ethnically diverse cohort from the UK: 8-year prospective study

Jayati Das-Munshi; Chin Kuo Chang; Peter Schofield; Robert Stewart; Martin J. Prince

doi:10.1017/S0033291718002210

Depression and cause-specific mortality in an ethnically diverse cohort from the UK: 8-year prospective study

Jayati Das-Munshi^*, Chin Kuo Chang, Peter Schofield, Robert Stewart, Martin J. Prince

^*Corresponding author for this work

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Abstract

Background Depression is associated with increased mortality, however, little is known about its variation by ethnicity.

Methods We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007-2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures.

Results Data from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45-2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53-0.74) (Black Caribbean), 0.53(95% CI 0.39-0.72) (Black African) and 0.69(95% CI 0.52-0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68-2.24) and aHR:1.18 (95% CI 1.01-1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58-0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression.

Conclusions Although individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.

Original language	English
Pages (from-to)	1639-1651
Journal	Psychological Medicine
Volume	49
Issue number	10
Early online date	5 Sept 2018
DOIs	https://doi.org/10.1017/S0033291718002210
Publication status	Published - 1 Jul 2019

Keywords

All-cause mortality
depression
ethnicity
natural cause mortality
unipolar depression
unnatural cause mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Depression and cause specific mortality_Das-Munshi_2018_GOLD VoRFinal published version, 313 KBLicence: CC BY

Cite this

@article{93e8c3752ae4469eafe9e9bde2a16c4b,

title = "Depression and cause-specific mortality in an ethnically diverse cohort from the UK: 8-year prospective study",

abstract = "Background Depression is associated with increased mortality, however, little is known about its variation by ethnicity.Methods We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007-2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures.Results Data from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45-2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53-0.74) (Black Caribbean), 0.53(95% CI 0.39-0.72) (Black African) and 0.69(95% CI 0.52-0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68-2.24) and aHR:1.18 (95% CI 1.01-1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58-0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression.Conclusions Although individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.",

keywords = "All-cause mortality, depression, ethnicity, natural cause mortality, unipolar depression, unnatural cause mortality",

author = "Jayati Das-Munshi and Chang, {Chin Kuo} and Peter Schofield and Robert Stewart and Prince, {Martin J.}",

year = "2019",

month = jul,

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doi = "10.1017/S0033291718002210",

language = "English",

volume = "49",

pages = "1639--1651",

journal = "Psychological Medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

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TY - JOUR

T1 - Depression and cause-specific mortality in an ethnically diverse cohort from the UK

T2 - 8-year prospective study

AU - Das-Munshi, Jayati

AU - Chang, Chin Kuo

AU - Schofield, Peter

AU - Stewart, Robert

AU - Prince, Martin J.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background Depression is associated with increased mortality, however, little is known about its variation by ethnicity.Methods We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007-2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures.Results Data from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45-2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53-0.74) (Black Caribbean), 0.53(95% CI 0.39-0.72) (Black African) and 0.69(95% CI 0.52-0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68-2.24) and aHR:1.18 (95% CI 1.01-1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58-0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression.Conclusions Although individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.

AB - Background Depression is associated with increased mortality, however, little is known about its variation by ethnicity.Methods We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007-2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures.Results Data from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45-2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53-0.74) (Black Caribbean), 0.53(95% CI 0.39-0.72) (Black African) and 0.69(95% CI 0.52-0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68-2.24) and aHR:1.18 (95% CI 1.01-1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58-0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression.Conclusions Although individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.

KW - All-cause mortality

KW - depression

KW - ethnicity

KW - natural cause mortality

KW - unipolar depression

KW - unnatural cause mortality

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U2 - 10.1017/S0033291718002210

DO - 10.1017/S0033291718002210

M3 - Article

AN - SCOPUS:85052903456

SN - 0033-2917

VL - 49

SP - 1639

EP - 1651

JO - Psychological Medicine

JF - Psychological Medicine

IS - 10

ER -

Depression and cause-specific mortality in an ethnically diverse cohort from the UK: 8-year prospective study

Abstract

Keywords

UN SDGs

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