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Depression and Risk of Sudden Cardiac Death and Arrhythmias: A Meta-Analysis

Shi, Shaobo MD, PhD; Liu, Tao MD, PhD; Liang, Jinjun MD, PhD; Hu, Dan MD, PhD; Yang, Bo MD, PhD

doi: 10.1097/PSY.0000000000000382
Systematic Review/Meta-Analysis

Objective: Depression is an independent risk factor for cardiac events and mortality in individuals with or without cardiovascular disease (CVD), although the underlying mechanisms involved in sudden cardiac death (SCD) and arrhythmias remain unclear. This meta-analysis aimed to assess the relationship between depression and risk of SCD and arrhythmias.

Methods: We systematically searched MEDLINE, Elsevier, and PsycINFO databases for articles (January 1990 to June 2015) describing the correlation of depression (“depressive symptoms,” “depression,” or “depressive disorder”) with SCD or arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF], or atrial fibrillation [AF]). Data were meta-analyzed with random-effects models.

Results: A total of 17 studies met the inclusion criteria: 4 of SCD (n = 83,659), 8 of VT/VF (n = 4,048), and 5 of AF (n = 31,247). The total sample consisted of 8,533 individuals with and 110,421 individuals without previous CVD. Depression was associated with increased risk of SCD (hazard risk [HR], 1.62; 95% confidence interval [CI], 1.37–1.92; p < .001), VT/VF (HR, 1.47; 95% CI, 1.23–1.76; p < .001) and AF recurrence (HR, 1.88; 95% CI, 1.54–2.30; p < .001). There was no significant association, however, between depression and risk of new-onset AF (HR, 0.96; 95% CI, 0.87–1.04; p = .311).

Conclusions: Depression (clinical depression and depressive symptoms) is associated with increased risk of SCD, VT/VF, and AF recurrence. These findings suggest that arrhythmias play an important role in the association between depression and increased mortality in individuals with or without CVD. Systematic evaluation and treatment of depression may contribute to the prevention of lethal cardiac events in the general population and in high-risk individuals with CVD.

From the Department of Cardiology (Yang, Shi, Liu, Liang, Hu), Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Research Institute, Wuhan University, Wuhan, China (Yang, Shi, Liu, Liang, Hu); Masonic Medical Research Laboratory (Hu), Utica, New York.

Address correspondence and reprint requests to Bo Yang, MD, PhD, No. 238 Jiefang Rd, Wuchang District, Wuhan City Hubei Province, 430060, China. E-mail:

Received for publication July 21, 2015; revision received June 23, 2016.

Copyright © 2017 by American Psychosomatic Society
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