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Depression and excess mortality: evidence for a dose response relation in community living elderly
Author(s) -
Schoevers R. A.,
Geerlings M. I.,
Deeg D. J. H.,
Holwerda T. J.,
Jonker C.,
Beekman A. T. F.
Publication year - 2009
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.2088
Subject(s) - depression (economics) , late life depression , cohort , medicine , context (archaeology) , cohort study , gerontology , proportional hazards model , prospective cohort study , demography , psychiatry , cognition , macroeconomics , paleontology , biology , sociology , economics
Context Depression is associated with an increased mortality risk. It is not known to what extent depression characteristics such as severity and length of exposure to depression contribute to the association with excess mortality. Objectives To investigate the association between depression severity and duration with mortality in community‐living elderly. Design Two‐wave prospective cohort study with 10‐year follow‐up of vital status. Assessment of depression at baseline and at three year follow‐up (GMS‐AGECAT). Cox proportional hazards analyses of mortality with depression according to severity and length of exposure, adjusted for demographic variables, physical illnesses, cognitive decline and functional disabilities. Setting and participants Randomly selected cohort of 3 746 non‐demented older community‐living persons in the city of Amsterdam. Main outcome measures Excess mortality of both the baseline cohort, and of non‐demented subjects participating in both assessments ( n = 1989). Results Both moderate (MHR 1.29, 95% CI 1.03–1.61) and severe depression (MHR 1.34, 95% CI 1.07–1.68) predicted 10‐year mortality after multivariate adjustment. Chronic depression was associated with a 41% higher mortality risk in 6‐year follow‐up compared to subjects without depression. Conclusions Severity and chronicity of depression are associated with a higher mortality risk. In combination with other findings this is suggestive of a causal relationship and may have implications for both preventive and treatment strategies of late‐life depression. Copyright © 2008 John Wiley & Sons, Ltd.