Miloyan Beyon, Bulley Adam, Bandeen-Roche Karen, Eaton William W, Gonçalves-Bradley Daniela C
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
School of Psychology, The University of Queensland, St Lucia, QLD, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2016 Nov;51(11):1467-1475. doi: 10.1007/s00127-016-1284-6. Epub 2016 Sep 14.
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.
本研究旨在对前瞻性队列研究进行系统评价和荟萃分析，这些研究考察了基线时的焦虑症或具有临床意义的焦虑症状与随访时全因死亡率之间的关系，并与无临床显著焦虑的对照参与者进行比较。
检索了截至2015年7月的PubMed、EMBASE、PsycInfo和CINAHL数据库，同时对已发表的综述进行人工检索，并对纳入研究进行前后向滚雪球检索。如果焦虑未用标准化工具定义，或者参与者随访时间为1年或更短，则排除该研究。去除重复项后，初始检索得到7901篇文章，其中328篇进行了全文筛选。
36篇文章中的42个估计值纳入了荟萃分析，总样本量为127,552名参与者，死亡人数超过11,573人。临床焦虑参与者相对于对照的总体死亡率风险比（HR）估计值为1.09（95%CI 1.01 - 1.16）；然而，在调整发表偏倚后，该值降低（1.03；95%CI 0.95 - 1.13）。没有证据表明来自社区样本的焦虑参与者死亡率风险增加（0.99；95%CI 0.96 - 1.02），以及在调整了抑郁症诊断的研究中（1.01；95%CI 0.96 - 1.06）。
这些发现表明，文献中的阳性关联归因于较小样本的研究、参与者中的共病抑郁症（或其他精神疾病）以及对短期随访的医学患者样本可能存在的混杂因素。
