Objective
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.
Design
Prospective follow-up of the National Diet and Nutrition Survey in older adults.
Setting
Community sample.
Participants
A total of 1,007 participants (522 men, 485 women; mean age: 76.4 ± 7.3 years).
Measurements
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.
Results
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.
Conclusion
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.
Key words
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References
- The criterion validity of the Geriatric Depression Scale: a systematic review.Acta Psychiatr Scand. 2006; 114: 398-410
- Association between depression and mortality in older adults: the Cardiovascular Health Study.Arch Intern Med. 2000; 160: 1761-1768
- Association between depressive symptoms and mortality in older women. Study of Osteoporotic Fractures Research Group.Arch Intern Med. 1998; 158: 2129-2135
- Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression.Arch Gen Psychiatry. 2002; 59: 1046-1052
- 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
- Minor and major depression and the risk of death in older persons.Arch Gen Psychiatry. 1999; 56: 889-895
- Stronger symptoms of depression predict high coronary heart disease mortality in older men and women.Int J Geriatr Psychiatry. 2007; 22: 757-763
- Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis.Psychosom Med. 2004; 66: 802-813
- Subthreshold depression and successful aging in older women.Am J Geriatr Psychiatry. 2010; 18: 212-220
- Psychological distress as a risk factor for CVD events: pathophysiological and behavioural mechanisms.J Am Coll Cardiol. 2008; 52: 2156-2162
- Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease.JAMA. 2008; 300: 2379-2388
- 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
- Grip strength, body composition and mortality.Int J Epidemiol. 2007; 36: 228-235
- 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
- Changes in depression and physical decline in older adults: a longitudinal perspective.J Affect Disord. 2000; 61: 1-12
- 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
- Predictors of new onset depression in medically ill, disabled older adults at 1 Year follow-up.Am J Geriatr Psychiatry. 2009; 17: 802-809
- Persistent depressive symptomatology and inflammation: to what extent do health behaviours and weight control mediate this relationship?.Brain Behav Immun. 2009; 23: 413-418
- National Diet and Nutrition Survey: People Aged 65 Years or Over. Volume 1. Report of the Diet and Nutrition Survey. The Stationery Office, London1998
- Geriatric Depression Scale (GDS): recent evidence and development of a shorter version.Clin Gerontol. 1986; 37: 819-820
- 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
- Health perceptions and survival: do global evaluations of health status really predict mortality?.J Gerontol. 1991; 46: S55-S65
- Depressive symptoms and mortality in elderly persons.J Gerontol. 1992; 47: S80-S87
- 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
- Mortality in relation to dementia, depression, and social integration in an elderly community sample.Int J Geriatr Psychiatry. 1991; 6: 5-11
- The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey.J Gerontol. 1989; 44: S149-S156
- Co-morbidity with depression in older people.Aging Ment Health. 1997; : 157-162
- Etiologic factors in the onset of depressive symptoms in the older adults.J Abnorm Psychol. 1986; 95: 282-294
- Leisure time physical activity, risk of depressive symptoms, and inflammatory mediators: the English Longitudinal Study of Ageing.Psychoneuroen-docrinology. 2009; 34: 1050-1055
- 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
- Factors affecting the increased risk of physical inactivity among older people with depressive symptoms.Scand J Med Sci Sports. 2008; 19: 398-405
- Physical inactivity, depression, and risk of cardiovascular mortality.Med Sci Sports Exerc. 2007; 39: 1693-1699
- Depression as a risk factor for non-suicide mortality in the elderly.Biol Psychiatry. 2002; 52: 205-225
- Do psychological factors affect inflammation and incident coronary heart disease: the Whitehall II Study.Arterioscler Thromb Vasc Biol. 2008; 28: 1398-1406
- 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
- 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
- The emergence of depressive symptoms in later life: the importance of declining health and increasing disability.J Community Health. 1990; 15: 93-103
Article info
Publication history
Accepted:
November 3,
2009
Received in revised form:
October 25,
2009
Received:
July 6,
2009
Footnotes
The authors thank Claire Deverill and Marie Sanchez (NatCen) for assistance in obtaining the mortality data.
The survey was commissioned jointly by the Department of Health and the Ministry of Agriculture, Fisheries and Food, whose survey-responsibility has since been transferred to the Food Standards Agency. It was carried out by the National Centre for Social Research (NatCen), formerly Social and Community Planning Research (SCPR), in conjunction with the Micronutrient Status Laboratory of the MRC Dunn Nutrition Unit, now part of MRC Human Nutrition Research. The survey datasets were obtained from the survey commissioners, the University of Essex Data Archive and the Social Survey Division of the Office for National Statistics, and funding was also provided by The Medical Research Council. The funders have not influenced this research or its publication.
Identification
Copyright
© 2011 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
