The Devastating Link Between Depression and Shortened Lifespan

In a nutshell

  1. The link between depression and longevity is staggering.
  2. People who experience depression are almost twice as likely to experience premature death compared to those who do not have depression.
  3. This link between depression and lifespan is attributed to both biological factors and lifestyle factors.
  4. Early recognition, treatment, and prevention of depression can significantly improve healthspan and promote longevity.

Depression is a prevalent and debilitating mental health condition that affects millions of people worldwide. It not only impacts an individual’s emotional well-being but can also have significant consequences on physical health and lifespan.

People who are dealing with serious mental illnesses like schizophrenia, major depression, and bipolar disorders may have a shorter lifespan than those without these conditions. Studies suggest that their life expectancy can be reduced by up to 10-25 years compared to the general population.1 Fiorillo, A., Sartorius, N. Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Ann Gen Psychiatry 20, 52 (2021). https://doi.org/10.1186/s12991-021-00374-y Source

Depression is associated with a higher risk of all-cause mortality2 Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015 Apr;72(4):334-41. doi: 10.1001/jamapsychiatry.2014.2502. Erratum in: JAMA Psychiatry. 2015 Jul;72(7):736. Erratum in: JAMA Psychiatry. 2015 Dec;72(12):1259. PMID: 25671328; PMCID: PMC4461039. Source and some studies even estimated that people who experience depression are at nearly twice the risk of premature death compared to those who do not have depression.3 Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW. Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry. 2014 Apr;171(4):453-62. doi: 10.1176/appi.ajp.2013.13030325. PMID: 24434956. PubMed Source

Before diving into the mechanisms of interconnection between depression and longevity, let’s first have a look at what is depression and its main risk factors and symptoms.

What is depression?

Depression is a condition that affects a person’s mood, thoughts, and behaviors. It can make the person feel sad and hopeless, and lose interest in things they used to enjoy. Depression can be caused by many things, such as genetics, brain chemistry, life events, stress, and negative thinking patterns.

Risk Factors of Depression

There are several risk factors that can make a person more susceptible to developing depression.

  • Family history. People with a family history of depression or other mental health disorders may have a higher genetic predisposition to develop depression themselves.4 Zalar B, Blatnik A, Maver A, Klemenc-Ketiš Z, Peterlin B. Family History as an Important Factor for Stratifying Participants in Genetic Studies of Major Depression.Balkan J Med Genet. 2018 Oct 29;21(1):5-12. doi: 10.2478/bjmg-2018-0010. PMID: 30425904; PMCID: PMC6231308. PubMed Source
  • Gender. Women are nearly twice as likely as men to develop depression, probably due to hormonal fluctuations and social factors playing a leading role among other contributors. 5 Eid RS, Gobinath AR, Galea LAM. Sex differences in depression: Insights from clinical and preclinical studies. Prog Neurobiol. 2019 May;176:86-102. doi: 10.1016/j.pneurobio.2019.01.006. Epub 2019 Feb 2. PMID: 30721749. PubMed Source
  • History of mental illness or depression prior in life.6 Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin Psychol Rev. 2007 Dec;27(8):959-85. doi: 10.1016/j.cpr.2007.02.005. Epub 2007 Mar 3. PMID: 17448579; PMCID: PMC2169519.PubMed Source
  • Brain chemistry. Imbalances in some neurotransmitters (such as serotonin, dopamine, and norepinephrine) can predispose to depression development.7 Filatova EV, Shadrina MI, Slominsky PA. Major Depression: One Brain, One Disease, One Set of Intertwined Processes. Cells. 2021 May 21;10(6):1283. doi: 10.3390/cells10061283. PMID: 34064233; PMCID: PMC8224372. PubMed Source
  • Stressful life events.8 Kessler RC. The effects of stressful life events on depression. Annu Rev Psychol. 1997;48:191-214. doi: 10.1146/annurev.psych.48.1.191. PMID: 9046559. PubMed Source
  • Chronic medical conditions (such as diabetes, heart disease, or cancer).9 Ma, Y., Xiang, Q., Yan, C. et al. Relationship between chronic diseases and depression: the mediating effect of pain. BMC Psychiatry 21, 436 (2021). https://doi.org/10.1186/s12888-021-03428-3 PubMed Source
  • Substance abuse.10Quello SB, Brady KT, Sonne SC. Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect. 2005 Dec;3(1):13-21. doi: 10.1151/spp053113. PMID: 18552741; PMCID: PMC2851027. PubMed Source
  • Personality traits.11 Fanous A, Gardner CO, Prescott CA, Cancro R, Kendler KS. Neuroticism, major depression and gender: a population-based twin study. Psychol Med. 2002 May;32(4):719-28. doi: 10.1017/s003329170200541x. PMID: 12102386.PubMed Source People with certain personality traits, like high levels of neuroticism, low self-esteem, or a tendency to ruminate, are at higher risk.
  • Social isolation.12 Matthews T, Danese A, Wertz J, Odgers CL, Ambler A, Moffitt TE, Arseneault L. Social isolation, loneliness and depression in young adulthood: a behavioural genetic analysis. Soc Psychiatry Psychiatr Epidemiol. 2016 Mar;51(3):339-48. doi: 10.1007/s00127-016-1178-7. Epub 2016 Feb 3. PMID: 26843197; PMCID: PMC4819590. PubMed Source
  • Childhood trauma or abuse.13 Humphreys KL, LeMoult J, Wear JG, Piersiak HA, Lee A, Gotlib IH. Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. Child Abuse Negl. 2020 Apr;102:104361. doi: 10.1016/j.chiabu.2020.104361. Epub 2020 Feb 13. PMID: 32062423; PMCID: PMC7081433.PubMed Source
  • Hormonal imbalances (e.g. during pregnancy, or postpartum).14Ghaedrahmati M, Kazemi A, Kheirabadi G, Ebrahimi A, Bahrami M. Postpartum depression risk factors: A narrative review. J Educ Health Promot. 2017 Aug 9;6:60. doi: 10.4103/jehp.jehp_9_16. PMID: 28852652; PMCID: PMC5561681.PubMed Source

Symptoms of Depression

The main symptoms of depression include:

  • Persistent sad, anxious, or “empty” mood
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Feelings of hopelessness or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Decreased energy or fatigue
  • Difficulty concentrating, remembering, or making decisions
  • Insomnia or sleeping too much (hypersomnia)
  • Appetite or weight changes (significant weight loss or gain)
  • Thoughts of death or suicide, suicide attempts

How Depression Affects Longevity: Biological Mechanisms

It’s important to recognize the connection between depression and a reduced lifespan because it helps us to better understand how we can support those who are dealing with this mental health challenge.

Inflammation and Immune System Dysregulation

Studies have shown that depression can lead to higher levels of inflammation and immune system disruption. In particular, individuals with depression have been found to have elevated levels of pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α).15 Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, Lanctôt KL. A meta-analysis of cytokines in major depression. Biol Psychiatry. 2010 Mar 1;67(5):446-57. doi: 10.1016/j.biopsych.2009.09.033. Epub 2009 Dec 16. PMID: 20015486. PubMed Source

When inflammation becomes chronic during long-term depression, it can increase the risk of developing age-related conditions such as cardiovascular disease, type 2 diabetes, and neurodegenerative disorders, which can ultimately impact lifespan.16 Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci. 2014 Jun;69 Suppl 1:S4-9. doi: 10.1093/gerona/glu057. PMID: 24833586. PubMed Source

Hormonal Imbalances

Depression is also associated with hormonal imbalances, particularly with our stress-response system, called the hypothalamic-pituitary-adrenal (HPA) axis. When this system is not working properly, it can lead to higher levels of a hormone called cortisol, which is associated with stress.17 Pariante CM, Lightman SL. The HPA axis in major depression: classical theories and new developments. Trends Neurosci. 2008 Sep;31(9):464-8. doi: 10.1016/j.tins.2008.06.006. Epub 2008 Jul 31. PMID: 18675469. PubMed Source

When cortisol levels remain high for a long time, it can increase the risk of other health problems such as metabolic syndrome, osteoporosis, and cognitive decline.18Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009 Jul;5(7):374-81. doi: 10.1038/nrendo.2009.106. Epub 2009 Jun 2. PMID: 19488073. PubMed Source This can impact our health in the long term.

Telomere Shortening

Telomeres are protective structures found at the ends of chromosomes that help maintain genomic stability.

Recent studies have found that people who experience depression have shorter telomeres, which can speed up the aging process of the cells and increase the risk of age-related diseases.19 Ridout KK, Ridout SJ, Price LH, Sen S, Tyrka AR. Depression and telomere length: A meta-analysis. J Affect Disord. 2016 Feb;191:237-47. doi: 10.1016/j.jad.2015.11.052. Epub 2015 Dec 2. PMID: 26688493; PMCID: PMC4760624. PubMed Source Shorter telomere length is one of the hallmarks of biological aging, and this link between depression and telomere length suggests that depression may impact our lifespan.20 Vakonaki E, Tsiminikaki K, Plaitis S, Fragkiadaki P, Tsoukalas D, Katsikantami I, Vaki G, Tzatzarakis MN, Spandidos DA, Tsatsakis AM. Common mental disorders and association with telomere length. Biomed Rep. 2018 Feb;8(2):111-116. doi: 10.3892/br.2018.1040. Epub 2018 Jan 8. PMID: 29435268; PMCID: PMC5778888.PubMed Source


How Depression Affects Longevity: The Role of Lifestyle Factors


Many lifestyle factors can affect our overall health and longevity, especially for those living with depression. Unfortunately, people with depression are prone to make poor lifestyle choices that exacerbate depression even more.

Poor Self-care

Depression can negatively impact an individual’s ability to engage in proper self-care, including maintaining a healthy diet, getting regular exercise, and ensuring adequate sleep.

A poor diet can lead to nutritional deficiencies, obesity, and an increased risk of chronic diseases like heart disease and diabetes, which can shorten one’s lifespan. Additionally, a lack of physical activity has been linked to a higher risk of mortality.21 Rebar AL, Stanton R, Geard D, Short C, Duncan MJ, Vandelanotte C. A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychol Rev. 2015;9(3):366-78. doi: 10.1080/17437199.2015.1022901. Epub 2015 Jul 3. PMID: 25739893. PubMed Source

Lastly, sleep disturbances, which are common in depression, can contribute to a weakened immune system, cognitive decline, and other health issues.22 Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Lombardo C, Riemann D. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011 Dec;135(1-3):10-9. doi: 10.1016/j.jad.2011.01.011. Epub 2011 Feb 5. PMID: 21300408. PubMed Source

Increased Substance Abuse

People who experience depression may turn to alcohol or drugs as a way to cope, but this can lead to a lot of health problems.23 McHugh RK, Weiss RD. Alcohol Use Disorder and Depressive Disorders. Alcohol Res. 2019 Jan 1;40(1):arcr.v40.1.01. doi: 10.35946/arcr.v40.1.01. PMID: 31649834; PMCID: PMC6799954. PubMed Source Substance abuse can lead to liver damage, heart disease, and an increased risk of accidents or injuries, all of which can negatively impact longevity.

Social Isolation

Depression can make people want to be alone and avoid spending time with others, which can make them feel lonely and isolated. Unfortunately, social isolation has been linked to an increased risk of death, similar to other well-known risks like smoking and being overweight.24 Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010 Jul 27;7(7):e1000316. doi: 10.1371/journal.pmed.1000316. PMID: 20668659; PMCID: PMC2910600. PubMed Source

Having meaningful social connections is essential for being healthy and living a long life.25 House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988 Jul 29;241(4865):540-5. doi: 10.1126/science.3399889. PMID: 3399889. PubMed Source


Depression and isolation are strongly interconnected.

Treatment and Prevention Strategies for Depression

As we can see, depression is a complex disorder affecting many systems of the body through different pathways. So how can we prevent it and help people who have already developed this condition? Fortunately, there are many effective ways to do this.

Early Detection and Intervention

When it comes to depression, early detection and intervention are crucial in mitigating its long-term effects on overall health and longevity. Recognizing the signs and symptoms of depression and seeking help promptly can lead to more effective treatment outcomes and reduced risk of chronic health issues.26 Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003 Jun 18;289(23):3095-105. doi: 10.1001/jama.289.23.3095. PMID: 12813115.PubMed Source

Treatment for Depression

  • Psychotherapy or talk therapy. This is an effective treatment for depression that can help individuals learn to cope with their emotions and develop healthier thought patterns. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are well-established psychotherapeutic approaches for treating depression as well.27 Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007 Apr;27(3):318-26. doi: 10.1016/j.cpr.2006.11.001. Epub 2006 Dec 19. PMID: 17184887. PubMed Source
  • Medications. Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can help regulate mood by targeting neurotransmitter imbalances in the brain. These medications are often used in conjunction with psychotherapy for optimal results.28 Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ, Rosenbaum JF, Sackeim HA, Kupfer DJ, Luther J, Fava M. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov;163(11):1905-17. doi: 10.1176/ajp.2006.163.11.1905. PMID: 17074942. PubMed Source
  • Lifestyle Modifications. Incorporating healthy lifestyle habits can complement traditional treatments for depression and improve overall well-being. Regular exercise, a balanced diet, good sleep hygiene, socialization, incorporating relaxation and meditation, and pet therapy have been shown to alleviate depressive symptoms and enhance mental health.29 Sarris J, O’Neil A, Coulson CE, Schweitzer I, Berk M. Lifestyle medicine for depression. BMC Psychiatry. 2014 Apr 10;14:107. doi: 10.1186/1471-244X-14-107. PMID: 24721040; PMCID: PMC3998225.PubMed Source

Prevention Strategies

  • Building resilience through stress management techniques, such as mindfulness meditation or yoga, can help people better cope with life’s challenges and reduce the risk of developing depression.30 Kuyken W, Warren FC, Taylor RS, Whalley B, Crane C, Bondolfi G, Hayes R, Huijbers M, Ma H, Schweizer S, Segal Z, Speckens A, Teasdale JD, Van Heeringen K, Williams M, Byford S, Byng R, Dalgleish T. Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. JAMA Psychiatry. 2016 Jun 1;73(6):565-74. doi: 10.1001/jamapsychiatry.2016.0076. PMID: 27119968; PMCID: PMC6640038. PubMed Source
  • Fostering strong social connections can also provide emotional support during difficult times and promote overall mental health.31 Weziak-Bialowolska D, Bialowolski P, Lee MT, Chen Y, VanderWeele TJ, McNeely E. Prospective Associations Between Social Connectedness and Mental Health. Evidence From a Longitudinal Survey and Health Insurance Claims Data. Int J Public Health. 2022 Jun 9;67:1604710. doi: 10.3389/ijph.2022.1604710. PMID: 35755953; PMCID: PMC9218058.PubMed Source

Recap and final thoughts

Depression is strongly linked to longevity, as those who experience it are almost twice as likely to die prematurely. Biological and lifestyle factors contribute to this link. By understanding this connection, we can better take care of ourselves or support loved ones with depression.

References

  • 1
    Fiorillo, A., Sartorius, N. Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Ann Gen Psychiatry 20, 52 (2021). https://doi.org/10.1186/s12991-021-00374-y Source
  • 2
    Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015 Apr;72(4):334-41. doi: 10.1001/jamapsychiatry.2014.2502. Erratum in: JAMA Psychiatry. 2015 Jul;72(7):736. Erratum in: JAMA Psychiatry. 2015 Dec;72(12):1259. PMID: 25671328; PMCID: PMC4461039. Source
  • 3
    Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW. Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry. 2014 Apr;171(4):453-62. doi: 10.1176/appi.ajp.2013.13030325. PMID: 24434956. PubMed Source
  • 4
    Zalar B, Blatnik A, Maver A, Klemenc-Ketiš Z, Peterlin B. Family History as an Important Factor for Stratifying Participants in Genetic Studies of Major Depression.Balkan J Med Genet. 2018 Oct 29;21(1):5-12. doi: 10.2478/bjmg-2018-0010. PMID: 30425904; PMCID: PMC6231308. PubMed Source
  • 5
    Eid RS, Gobinath AR, Galea LAM. Sex differences in depression: Insights from clinical and preclinical studies. Prog Neurobiol. 2019 May;176:86-102. doi: 10.1016/j.pneurobio.2019.01.006. Epub 2019 Feb 2. PMID: 30721749. PubMed Source
  • 6
    Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin Psychol Rev. 2007 Dec;27(8):959-85. doi: 10.1016/j.cpr.2007.02.005. Epub 2007 Mar 3. PMID: 17448579; PMCID: PMC2169519.PubMed Source
  • 7
    Filatova EV, Shadrina MI, Slominsky PA. Major Depression: One Brain, One Disease, One Set of Intertwined Processes. Cells. 2021 May 21;10(6):1283. doi: 10.3390/cells10061283. PMID: 34064233; PMCID: PMC8224372. PubMed Source
  • 8
    Kessler RC. The effects of stressful life events on depression. Annu Rev Psychol. 1997;48:191-214. doi: 10.1146/annurev.psych.48.1.191. PMID: 9046559. PubMed Source
  • 9
    Ma, Y., Xiang, Q., Yan, C. et al. Relationship between chronic diseases and depression: the mediating effect of pain. BMC Psychiatry 21, 436 (2021). https://doi.org/10.1186/s12888-021-03428-3 PubMed Source
  • 10
    Quello SB, Brady KT, Sonne SC. Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect. 2005 Dec;3(1):13-21. doi: 10.1151/spp053113. PMID: 18552741; PMCID: PMC2851027. PubMed Source
  • 11
    Fanous A, Gardner CO, Prescott CA, Cancro R, Kendler KS. Neuroticism, major depression and gender: a population-based twin study. Psychol Med. 2002 May;32(4):719-28. doi: 10.1017/s003329170200541x. PMID: 12102386.PubMed Source
  • 12
    Matthews T, Danese A, Wertz J, Odgers CL, Ambler A, Moffitt TE, Arseneault L. Social isolation, loneliness and depression in young adulthood: a behavioural genetic analysis. Soc Psychiatry Psychiatr Epidemiol. 2016 Mar;51(3):339-48. doi: 10.1007/s00127-016-1178-7. Epub 2016 Feb 3. PMID: 26843197; PMCID: PMC4819590. PubMed Source
  • 13
    Humphreys KL, LeMoult J, Wear JG, Piersiak HA, Lee A, Gotlib IH. Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. Child Abuse Negl. 2020 Apr;102:104361. doi: 10.1016/j.chiabu.2020.104361. Epub 2020 Feb 13. PMID: 32062423; PMCID: PMC7081433.PubMed Source
  • 14
    Ghaedrahmati M, Kazemi A, Kheirabadi G, Ebrahimi A, Bahrami M. Postpartum depression risk factors: A narrative review. J Educ Health Promot. 2017 Aug 9;6:60. doi: 10.4103/jehp.jehp_9_16. PMID: 28852652; PMCID: PMC5561681.PubMed Source
  • 15
    Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, Lanctôt KL. A meta-analysis of cytokines in major depression. Biol Psychiatry. 2010 Mar 1;67(5):446-57. doi: 10.1016/j.biopsych.2009.09.033. Epub 2009 Dec 16. PMID: 20015486. PubMed Source
  • 16
    Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci. 2014 Jun;69 Suppl 1:S4-9. doi: 10.1093/gerona/glu057. PMID: 24833586. PubMed Source
  • 17
    Pariante CM, Lightman SL. The HPA axis in major depression: classical theories and new developments. Trends Neurosci. 2008 Sep;31(9):464-8. doi: 10.1016/j.tins.2008.06.006. Epub 2008 Jul 31. PMID: 18675469. PubMed Source
  • 18
    Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009 Jul;5(7):374-81. doi: 10.1038/nrendo.2009.106. Epub 2009 Jun 2. PMID: 19488073. PubMed Source
  • 19
    Ridout KK, Ridout SJ, Price LH, Sen S, Tyrka AR. Depression and telomere length: A meta-analysis. J Affect Disord. 2016 Feb;191:237-47. doi: 10.1016/j.jad.2015.11.052. Epub 2015 Dec 2. PMID: 26688493; PMCID: PMC4760624. PubMed Source
  • 20
    Vakonaki E, Tsiminikaki K, Plaitis S, Fragkiadaki P, Tsoukalas D, Katsikantami I, Vaki G, Tzatzarakis MN, Spandidos DA, Tsatsakis AM. Common mental disorders and association with telomere length. Biomed Rep. 2018 Feb;8(2):111-116. doi: 10.3892/br.2018.1040. Epub 2018 Jan 8. PMID: 29435268; PMCID: PMC5778888.PubMed Source
  • 21
    Rebar AL, Stanton R, Geard D, Short C, Duncan MJ, Vandelanotte C. A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychol Rev. 2015;9(3):366-78. doi: 10.1080/17437199.2015.1022901. Epub 2015 Jul 3. PMID: 25739893. PubMed Source
  • 22
    Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Lombardo C, Riemann D. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011 Dec;135(1-3):10-9. doi: 10.1016/j.jad.2011.01.011. Epub 2011 Feb 5. PMID: 21300408. PubMed Source
  • 23
    McHugh RK, Weiss RD. Alcohol Use Disorder and Depressive Disorders. Alcohol Res. 2019 Jan 1;40(1):arcr.v40.1.01. doi: 10.35946/arcr.v40.1.01. PMID: 31649834; PMCID: PMC6799954. PubMed Source
  • 24
    Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010 Jul 27;7(7):e1000316. doi: 10.1371/journal.pmed.1000316. PMID: 20668659; PMCID: PMC2910600. PubMed Source
  • 25
    House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988 Jul 29;241(4865):540-5. doi: 10.1126/science.3399889. PMID: 3399889. PubMed Source
  • 26
    Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003 Jun 18;289(23):3095-105. doi: 10.1001/jama.289.23.3095. PMID: 12813115.PubMed Source
  • 27
    Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007 Apr;27(3):318-26. doi: 10.1016/j.cpr.2006.11.001. Epub 2006 Dec 19. PMID: 17184887. PubMed Source
  • 28
    Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ, Rosenbaum JF, Sackeim HA, Kupfer DJ, Luther J, Fava M. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov;163(11):1905-17. doi: 10.1176/ajp.2006.163.11.1905. PMID: 17074942. PubMed Source
  • 29
    Sarris J, O’Neil A, Coulson CE, Schweitzer I, Berk M. Lifestyle medicine for depression. BMC Psychiatry. 2014 Apr 10;14:107. doi: 10.1186/1471-244X-14-107. PMID: 24721040; PMCID: PMC3998225.PubMed Source
  • 30
    Kuyken W, Warren FC, Taylor RS, Whalley B, Crane C, Bondolfi G, Hayes R, Huijbers M, Ma H, Schweizer S, Segal Z, Speckens A, Teasdale JD, Van Heeringen K, Williams M, Byford S, Byng R, Dalgleish T. Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. JAMA Psychiatry. 2016 Jun 1;73(6):565-74. doi: 10.1001/jamapsychiatry.2016.0076. PMID: 27119968; PMCID: PMC6640038. PubMed Source
  • 31
    Weziak-Bialowolska D, Bialowolski P, Lee MT, Chen Y, VanderWeele TJ, McNeely E. Prospective Associations Between Social Connectedness and Mental Health. Evidence From a Longitudinal Survey and Health Insurance Claims Data. Int J Public Health. 2022 Jun 9;67:1604710. doi: 10.3389/ijph.2022.1604710. PMID: 35755953; PMCID: PMC9218058.PubMed Source
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