Follow up study of longstanding depression as predictor of mortality in elderly people living in the community

Abstract

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...

Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

“…Our findings are consistent with previous data regarding the effects of persistence of depressive symptoms on excess mortaUty (Pulska et al 1999;Geerlings et al 2002;Barry et al 2008;Schoevers et al 2009;Zhang et al 2009;Bogner et al 2011), but extend the magnitude of the association demonstiating that total or partial remission of symptoms is associated with a significant reduction in mortaUty. To our knowledge, this is the first study on this aspect of the relationship between longitudinal changes in depression and mortality conducted on a large sample of elderly subjects, of both genders, with a relatively long foUow-up, based on aü-cause mortaUty.…”

“…It has been argued that different lengths of exposure to depression may affect the association with mortality beeause with a longer duration the negative effeets on both biologieal and psyehosoeial functioning should have more time to accumulate (Sehoevers et al 2009). OveraU, the results of previous studies suggest that long-standing depression prediets mortaUty even after eontroUing for possible eonfounding faetors (Pulska et al 1999) and that both severity and persistenee of depression are associated with a higher mortality risk (GeerUngs et al 2002;Sehoevers et al 2009;Zhang et al 2009;Bogner et al 2011). Aeeording to the few studies analyzing gender differenees, changes in depressive status, and in incident depression in partieular, are associated with all-cause (Anstey & Luszcz, 2002) and cardiovascular disease mortaUty (Penninx et al 1998) only for elderly men, whereas the higher burden of depression in women may be attributable to a greater suseeptibUity to depression, a higher persistenee of the eondition and a lower probabUity of death (Barry et al 2008).…”

“…Moreover, even studies with multiple measurements of late-life depression have focused on the negative effeets of duration and persistenee on mortaUty (Penninx et al 1998;Pulska et al 1999;Anstey & Luszcz, 2002;GeerUngs et al 2002;Barry et al 2008;Sehoevers et al 2009;Zhang et al 2009;Bogner et al 2011).…”

Activity loss and the onset of depressive symptoms: Do some activities matter more than others?

“…Depressed persons have been found to use more health services than nondepressed persons (5,(30)(31)(32), and depression has been shown to exert a negative influence on health in diverse ways, including increasing the risk of physical decline (33,34) and increasing the risk for mortality (24,35). While the overall effect of RA on individuals' valued life activities appears to affect their psychological well-being, it also appears that specific domains of functioning may be more closely linked to psychological status than others.…”

Depression, cardiac mortality and all-cause mortality

“…Second, Pulska et al (1999) examined an older community population (813 participants: mean age 74.3 years, s.d. = 6.1) also using a case-control design.…”