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

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.