Depression and Risk of Sudden Cardiac Death and Arrhythmias: A Systematic Review and Meta-Analysis
Yao You1, Yongmin Shi1, Qingwen Yu1
1Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences, Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System&Ministry of Education, Hangzhou Normal University, 310015 Hangzhou, Zhejiang, China.
Insights
Depression significantly increases the risk of sudden cardiac death (SCD) and arrhythmias like atrial fibrillation (AF) and ventricular tachycardia/fibrillation (VT/VF). Mental health screening is crucial for cardiovascular risk management.
Area of Science:
- Cardiology
- Psychiatry
- Epidemiology
Background:
- Depression is a global mental health issue often linked to physical symptoms.
- Existing research suggests a connection between depression and cardiac electrical instability, including sudden cardiac death (SCD) and arrhythmias.
- This review systematically examines the relationship between depression and the risks of SCD, atrial fibrillation (AF), and ventricular arrhythmias.
Purpose of the Study:
- To systematically evaluate the association between depression and the risk of sudden cardiac death (SCD).
- To assess the correlation between depression and the incidence of atrial fibrillation (AF).
- To investigate the link between depression and the occurrence of ventricular arrhythmias (VT/VF).
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines.
- Comprehensive literature search across PubMed, Embase, Web of Science, and Chinese databases up to April 10, 2025.
- Inclusion of cohort studies, with statistical analysis using random effects models and software like Review Manager 5.4 and STATA 16.0.
Main Results:
- Twenty studies were included, revealing a significant association between depression and increased risk of SCD (HR: 2.52).
- Depression was also significantly correlated with ventricular tachycardia/ventricular fibrillation (VT/VF) (HR: 1.38).
- Depression was linked to higher rates of AF recurrence (HR: 1.89) compared to new-onset AF (HR: 1.10).
Conclusions:
- This meta-analysis confirms a significant association between depression and elevated risks of SCD and arrhythmias (AF, VT/VF).
- Findings emphasize the critical need to integrate mental health assessments into cardiovascular risk management strategies.
- Proactive management of depression may be essential for reducing cardiac event risks.
Background:
Depression is a highly prevalent mental disorder worldwide and is often accompanied by various somatic symptoms. Clinical studies have suggested a close association between depression and cardiac electrophysiological instability, particularly sudden cardiac death (SCD) and arrhythmias. Therefore, this review systematically evaluated the association between depression and the risks of SCD, atrial fibrillation (AF), and ventricular arrhythmias.
Methods:
This analysis was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The PubMed, Embase, Web of Science, China National Knowledge Infrastructure, VIP, and Wanfang databases were comprehensively searched to identify studies that indicated a correlation between depression and the risk of SCD and arrhythmias from database inception until April 10, 2025. Numerous well-qualified cohort studies were incorporated in this analysis. Correlation coefficients were computed using a random effects model. Statistical analyses were performed using Review Manager 5.4 and STATA 16.0.
Results:
A total of 20 studies were included in this meta-analysis. We explored the relationship between depression and SCD as well as arrhythmias. Of these diseases, SCD exhibited a statistically significant association with depression (hazard ratio (HR), 2.52, 95% confidence interval (CI): 1.82-3.49). Ventricular tachycardia (VT)/ventricular fibrillation (VF) was also significantly correlated with depression (HR): 1.38, 95% CI: 1.03-1.86). Depression was also considerably more likely to develop following AF. The results also indicated that AF recurrence (HR: 1.89, 95% CI: 1.54-2.33) was more significant than new-onset AF (HR: 1.10, 95% CI: 0.98-1.25).
Conclusions:
This study highlights a significant association between depression and elevated risks of SCD and arrhythmias, including both AF and VT/VF. These findings underscore the importance of incorporating mental health evaluation into comprehensive cardiovascular risk management strategies.
The Prospero Registration:
CRD42024498196, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024498196.
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