Depression, Physical Function, and Risk of Mortality: National Diet and Nutrition Survey in Adults Older Than 65 Years


      The authors used an objective assessment of physical function and a range of sociodemographic, dietary, and health behaviors to explore the possible factors that could explain the association between depression and mortality in community-dwelling elderly participants aged 65 years and older.


      Prospective follow-up of the National Diet and Nutrition Survey in older adults.


      Community sample.


      A total of 1,007 participants (522 men, 485 women; mean age: 76.4 ± 7.3 years).


      Depression was assessed from the 15 item Geriatric Depression Scale (GDS) and physical function using hand grip strength. Participants were followed up for death over an average of 9.2 years.


      At baseline, 20.9% of participants demonstrated depression (GDS-15 score ≥5). Depressed participants were at a higher relative risk of all cause mortality during follow-up (age- and sex-adjusted hazard ratio = 1.24, 95% confidence interval: 1.04–1.49). Other risk factors for depression also related to mortality included smoking, physical inactivity, and low grip strength. These factors collectively explained an estimated 54% of the association between depression and mortality. Low-grade inflammation and low plasma vitamin C were also independently associated with depression and mortality but did not explain any of the association between depression and mortality.


      Late-life depression is associated with a higher risk of mortality. Physical inactivity and physical dysfunction might partly mediate this association, although further longitudinal studies are required to fully elucidate these mechanisms.

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        • Wancata J
        • Alexandrowicz R
        • Marquart B
        • et al.
        The criterion validity of the Geriatric Depression Scale: a systematic review.
        Acta Psychiatr Scand. 2006; 114: 398-410
        • Schulz R
        • Beach SR
        • Ives DG
        • et al.
        Association between depression and mortality in older adults: the Cardiovascular Health Study.
        Arch Intern Med. 2000; 160: 1761-1768
        • Whooley MA
        • Browner WS
        Association between depressive symptoms and mortality in older women. Study of Osteoporotic Fractures Research Group.
        Arch Intern Med. 1998; 158: 2129-2135
        • Ganguli M
        • Dodge HH
        • Mulsant BH
        Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression.
        Arch Gen Psychiatry. 2002; 59: 1046-1052
        • Blazer DG
        • Hybels CF
        • Pieper CF
        The association of depression and mortality in elderly persons: a case for multiple, independent pathways.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M505-M509
        • Penninx BW
        • Geerlings SW
        • Deeg DJ
        • et al.
        Minor and major depression and the risk of death in older persons.
        Arch Gen Psychiatry. 1999; 56: 889-895
        • Ahto M
        • Isoaho R
        • Puolijoki H
        • et al.
        Stronger symptoms of depression predict high coronary heart disease mortality in older men and women.
        Int J Geriatr Psychiatry. 2007; 22: 757-763
        • Barth J
        • Schumacher M
        • Herrmann-Lingen C
        Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis.
        Psychosom Med. 2004; 66: 802-813
        • Vahia IV
        • Meeks TW
        • Thompson WK
        • et al.
        Subthreshold depression and successful aging in older women.
        Am J Geriatr Psychiatry. 2010; 18: 212-220
        • Hamer M
        • Molloy GJ
        • Stamatakis E
        Psychological distress as a risk factor for CVD events: pathophysiological and behavioural mechanisms.
        J Am Coll Cardiol. 2008; 52: 2156-2162
        • Whooley MA
        • de Jonge P
        • Vittinghoff E
        • et al.
        Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease.
        JAMA. 2008; 300: 2379-2388
        • Lang IA
        • Guralnik JM
        • Melzer D
        Physical activity in middle-aged adults reduces risks of functional impairment independent of its effect on weight.
        J Am Geriatr Soc. 2007; 55: 1836-1841
        • Gale CR
        • Martyn CN
        • Cooper C
        • et al.
        Grip strength, body composition and mortality.
        Int J Epidemiol. 2007; 36: 228-235
        • Newman AB
        • Kupelian V
        • Visser M
        • et al.
        Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort.
        J Gerontol A Biol Sci Med Sci. 2006; 61: 72-77
        • Penninx BW
        • Deeg DJ
        • van Eijk JT
        • et al.
        Changes in depression and physical decline in older adults: a longitudinal perspective.
        J Affect Disord. 2000; 61: 1-12
        • Dalle Carbonare L
        • Maggi S
        • Noale M
        • ILSA Working Group
        • et al.
        Physical disability and depressive symptomatology in an elderly population: a complex relationship. The Italian Longitudinal Study on Aging (ILSA).
        Am J Geriatr Psychiatry. 2009; 17: 144-154
        • Weinberger MI
        • Raue PJ
        • Meyers BS
        • et al.
        Predictors of new onset depression in medically ill, disabled older adults at 1 Year follow-up.
        Am J Geriatr Psychiatry. 2009; 17: 802-809
        • Hamer M
        • Molloy GJ
        • de Oliveira C
        • et al.
        Persistent depressive symptomatology and inflammation: to what extent do health behaviours and weight control mediate this relationship?.
        Brain Behav Immun. 2009; 23: 413-418
        • Finch S
        • Doyle W
        • Lowe C
        • et al.
        National Diet and Nutrition Survey: People Aged 65 Years or Over. Volume 1. Report of the Diet and Nutrition Survey. The Stationery Office, London1998
        • Sheikh JI
        • Yesageve JA
        Geriatric Depression Scale (GDS): recent evidence and development of a shorter version.
        Clin Gerontol. 1986; 37: 819-820
        • Lyness JM
        • Noel TK
        • Cox C
        • et al.
        Screening for depression in elderly primary care patients. A Comparison of the Centre for Epidemiological Studies-Depression Scale and the Geriatric Depression Scale.
        Arch Intern Med. 1997; 24: 449-454
        • Idler EL
        • Kasl SV
        Health perceptions and survival: do global evaluations of health status really predict mortality?.
        J Gerontol. 1991; 46: S55-S65
        • Thomas C
        • Kelman HR
        • Kennedy GJ
        • et al.
        Depressive symptoms and mortality in elderly persons.
        J Gerontol. 1992; 47: S80-S87
        • Vogt T
        • Pope C
        • Mullooly J
        • et al.
        Mental health status as a predictor of morbidity and mortality: a 15-year follow up of members of a health maintenance organization.
        Am J Public Health. 1994; 84: 227-231
        • Jorm AF
        • Henderson AS
        • Kay DWK
        • et al.
        Mortality in relation to dementia, depression, and social integration in an elderly community sample.
        Int J Geriatr Psychiatry. 1991; 6: 5-11
        • Fredman L
        • Schoebarch VJ
        • Kaplan BH
        • et al.
        The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey.
        J Gerontol. 1989; 44: S149-S156
        • Katona C
        • Manuela M
        • Livingston G
        Co-morbidity with depression in older people.
        Aging Ment Health. 1997; : 157-162
        • Phifer JF
        • Murrell SA
        Etiologic factors in the onset of depressive symptoms in the older adults.
        J Abnorm Psychol. 1986; 95: 282-294
        • Hamer M
        • Molloy GJ
        • de Oliveira C
        • et al.
        Leisure time physical activity, risk of depressive symptoms, and inflammatory mediators: the English Longitudinal Study of Ageing.
        Psychoneuroen-docrinology. 2009; 34: 1050-1055
        • Yoshiuchi K
        • Nakahara R
        • Kumano H
        • et al.
        Yearlong physical activity and depressive symptoms in older Japanese adults: cross-sectional data from the Nakanojo study.
        Am J Geriatr Psychiatry. 2006; 14: 621-624
        • Rosqvist E
        • Heikkinen E
        • Lyyra TM
        • et al.
        Factors affecting the increased risk of physical inactivity among older people with depressive symptoms.
        Scand J Med Sci Sports. 2008; 19: 398-405
        • Kamphuis MH
        • Geerlings MI
        • Tijhuis MA
        • et al.
        Physical inactivity, depression, and risk of cardiovascular mortality.
        Med Sci Sports Exerc. 2007; 39: 1693-1699
        • Schulz R
        • Drayer RA
        • Rollman BL
        Depression as a risk factor for non-suicide mortality in the elderly.
        Biol Psychiatry. 2002; 52: 205-225
        • Nabi H
        • Singh-Manoux A
        • Shipley M
        • et al.
        Do psychological factors affect inflammation and incident coronary heart disease: the Whitehall II Study.
        Arterioscler Thromb Vasc Biol. 2008; 28: 1398-1406
        • Empana JP
        • Sykes DH
        • Luc G
        • PRIME Study Group
        • et al.
        Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: the Prospective Epidemiological Study of Myocardial Infarction (PRIME).
        Circulation. 2005; 111: 2299-2305
        • Vaccarino V
        • Johnson BD
        • Sheps DS
        • National Heart, Lung, and Blood Institute
        • et al.
        Depression, inflammation, and incident cardiovascular disease in women with suspected coronary ischemia: the National Heart, Lung, and Blood Institute-sponsored WISE study.
        J Am Coll Cardiol. 2007; 50: 2044-2050

      Uncited references

        • Kennedy GL
        • Kelman HR
        • Thomas C
        The emergence of depressive symptoms in later life: the importance of declining health and increasing disability.
        J Community Health. 1990; 15: 93-103