Longstanding and recurrent depressive disorders are quite common in elderly people.1 2 Not much is known, however, of their clinical course and prognosis, including mortality. The need for treatment of longstanding, less severe depressive disorders is a matter of discussion.We studied the relation between longstanding or recurrent depressive disorders and mortality and that between recovery from depressive disorders and mortality in elderly people. Subjects, methods, and resultsThis study is based on the Ähtäri longitudinal epidemiological research project concerning depression in elderly people.1-3 The initial series consisted of people born in 1923 or earlier and living in the municipality of Ähtäri, Finland, on 1 January 1984 (n = 1529). In the first study in 1984-5 the participation rate was 91%. The follow up study was performed in 1989-90 with a participation rate of 94%. Depression was determined after semistructured interviews by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III). 1-3We examined mortality in subjects with a longstanding or recurrent course of depression and those who had recovered. Three groups were formed from those people without dementia who were alive in both 1984-5 and 1989-90: people depressed in both assessments (n = 78), people depressed in 1984-5 but not depressed in 1989-90 (n = 101), and people not depressed in both assessments (n = 634). The mean (SD) age of those participating in the follow up study was 74.3 (6.1) years on 1 January 1989. The mortality data from the official statistics were collected for a period from the individual examination days in 1989-90 to 31 December 1995.The causes of death did not differ between the groups, cardiovascular and cerebrovascular diseases and malignant neoplasms being the most common. According to Kaplan-Meier survival analysis, 48% of the people with depression at both time points had died compared with 26% in the group without depression at both times (P < 0.001). In the group with depression in 1984-5 but not in 1989-90, 31% had died, so the survival in this group did not differ from that in the group without depression at either time (P = 0.286). The role of depression as a predictor of mortality was analysed with Cox's proportional hazards model, with age, sex, smoking, physical health, and functional abilities taken into account. Longstanding depression predicted mortality even when these factors were controlled for, while recovery from depression did not (table). CommentLongstanding depression seems to be a predictor for mortality in elderly people. In this study the groups of depressed people were formed on the basis of two measurements at interval of 5 years, and there were no data on the course of depression between the measurements. We assumed, however, that subjects with depression at both time points were suffering from longstanding or recurrent depression, and that this group and the group with depression at the first time point but without depression at the second differed f...

In order to analyse the survival of elderly Finnish people with major depression, a total of 29 elderly (> or =65 years) subjects suffering from major depression (DSM-III criteria) and 853 non-depressed elderly subjects were followed up for 6 years. The Kaplan-Meier survival curves showed the survival of patients suffering from major depression to be poorer than that of non-depressed subjects. When age, sex, marital status, level of education, smoking habits, physical health, functional abilities and major depression were introduced into the Cox model, advanced age, male sex, smoking, poor physical health, reduced functional abilities and the occurrence of major depression were found to be related to higher levels of mortality. The results suggest that major depression in the elderly predicts higher mortality which is not explained by their poor baseline level of physical health alone.

Evidence of once measured depression is not predictive of increased mortality in an unselected elderly population (60+) when the other factors known to influence survival probability are taken into account.

The specific symptoms of depression associated with increased mortality in the depressed elderly are poorly known. The aim of this paper is to analyse the individual depressive symptoms measured by the Zung Self Rated Depression Scale (ZSDS) and the Hamilton Rating Scale for Depression (HRSD) in association with mortality among depressed elderly subjects. The population consisted of 169 depressed (DSM‐III criteria) aged (65+ years) persons from a Finnish epidemiological research project. The follow‐up for deaths continued for about 6 years. When age, sex, smoking, physical health and functional abilities were taken into account, dissatisfaction, weight loss and gastrointestinal symptoms (anorexia and constipation) predicted mortality together with high age and poor physical health. Weight loss was related to an increased risk of death, specifically in the depressed. Dissatisfaction and gastrointestinal symptoms were more general markers of increased mortality. Copyright © 2000 John Wiley & Sons, Ltd.

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