Depression and Mortality in Older Patients
Abstract & commentary
Source: Penninx BW, et al. Minor and major depression and the risk of death in older persons. Arch Gen Psychiatry 1999;56:719-724.
The association between depression and mortality in older community-dwelling populations is still unresolved. Although some data have shown an increased risk of mortality associated with major depression, the effect of depression severity and the relationship to health status, socioeconomic status, and other relevant factors remains unclear. The current study examines the effect of the severity of depression on mortality in a large elderly cohort from the Netherlands. A random sample was drawn from the population registries of several municipalities. A cohort of 3056 men and women, aged 55-85, were followed for four years; 62.5% of those recruited participated. Major depression was defined by DSM-IV criteria. Minor depression was defined by a score of higher than 16 on the Center for Epidemiological Studies Depression (CES-D) scale, a 20-item self-report scale with scores ranging from 0 to 60 points. The CES-D is documented to be a valid and reliable instrument in older populations. Deaths were traced through the registries of the municipalities. The study controlled for potentially confounding covariates, such as sociodemographics (age, sex, education, level of urbanization), health status (chronic disease status, disability), and health behaviors (smoking, alcohol, exercise). Participants were divided into groups with major, minor, and no depression.
The mean age of respondents was 70.6 years and 51.6% were female; 85.2% were not depressed, while 12.8% had a minor depression and 0.2% had a major depression. Patients with minor depression were significantly older, more often female, less educated, often living in urban areas, more diseased, more physically disabled, and physically inactive, and more often smokers. Similar findings were true of major depression, except that patients were significantly younger than for minor depression. In total, 561 (18.4%) patients died, with predictors of mortality being advance age, male sex, low level of education, high urbanization level, chronic disease, physical disability, low physical activity, and current smoking. The crude mortality rate per 1000 person-years was 39.5 for nondepressed, 71.0 for minor depressed, and 60.7 for major depressed patients. After adjustments for age and sex, minor depression increased risk by 1.65X overall, but with statistical significance only in men; major depression increased risk by 2.32X in both men and women. After adjustment for sociodemographics and chronic disease, persons with major depression had a 1.84X increased risk; with further adjustments of physical disability, smoking, and physical activity, the increased risk was by a factor of 1.68X.
Comment by Donald M. Hilty, MD
The present study found that minor depression among older men and major depression among older men and women increased the risk of dying in the four-year period of follow-up. Differences between men and women with regard to the effect of minor depression could be due to physiological and behavioral responses to stress, increased cardiac mortality for men, differences in how depression is reported or defined, and/or the availability of social support. As previously discussed, aggressive treatment of depression is warranted.
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