Association of Anxiety and Depression with Mortality in Rural Nepal: A 16-Year Longitudinal Community Cohort Study

Abstract

Background: Common mental health conditions are associated with increased mortality, but longitudinal evidence from low- and middle-income countries (LMICs) remains limited. We aimed to examine whether baseline depression and anxiety were associated with all-cause mortality over 16 years in rural Nepal. Methods: We conducted a 16-year prospective cohort study in rural Nepal. At baseline in 2000, 316 adults were assessed using Nepali-validated versions of the Beck Depression Inventory (BDI; cut-off ≥ 20) and Beck Anxiety Inventory (BAI; cut-off ≥ 17). In 2016, 297 participants were successfully followed up; 46 had died and verbal autopsy data were available for 40 deaths. Logistic regression models were adjusted for gender, ethnicity, age, education, and income. Results: Among the 297 participants followed up, 34% of participants scored above the cut-off for depression, 27% for anxiety, and 17% for both at baseline. Forty-six participants (15%) died during follow-up. Among the 40 deaths with completed verbal autopsy, chronic respiratory disease was the leading cause of death (23/40, 57.5%). Adjusted odds of mortality were higher among participants scoring above the cut-off for depression (OR 2.34, 95% CI 1.01–5.53), anxiety (OR 3.49, 95% CI 1.27–10.15), and comorbid depression and anxiety (OR 5.27, 95% CI 1.65–17.61). In the comorbidity-adjusted model, women had lower odds of mortality (OR 0.22, 95% CI 0.07–0.61) and Dalit participants had higher odds (OR 4.62, 95% CI 1.44–16.96). Conclusions: Anxiety and comorbid depression and anxiety were associated with higher mortality over 16 years. Depression alone was associated with mortality in logistic regression, but this association was not statistically significant in sensitivity analyses and should therefore be interpreted cautiously.