Persons with severe mental illness have a life expectancy about 25 years less than others, largely due to preventable diseases.
1What has perhaps received less attention until recently has been the increased mortality rate of persons with depression even when symptoms are relatively mild
- Colton C.W.
- Manderscheid R.W.
Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states.
Prev Chronic Dis. 2006; 3: 1-14
- Lesperance F.
- Frasure-Smith N.
- Talajic M.
- et al.
Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction.
Circulation. 2002; 105: 1049-1053
- Bush D.E.
- Ziegelstein R.C.
- Tayback M.
- et al.
Even minimal symptoms of depression increase mortality risk after acute myocardial infarction.[see comment].
Am J Cardiol. 2001; 88: 337-341
4or when constructs that map to depression but are not strictly a component of standard criteria are studied (e.g., hopelessness, pessimism).
- Gallo J.J.
- Rabins P.V.
- Lyketsos C.G.
- et al.
Depression without sadness: functional outcomes of nondysphoric depression in later life.
J Am Geriatr Soc. 1997; 45: 570-578
5Suicide does not account for the increased mortality: The vast majority of older persons with depression die of cardiovascular disease and other medical conditions. Depression acts through psychological, social, and behavioral mechanisms to increase mortality (e.g., depressed patients are less likely to adhere to treatment regimens for cardiac disease or diabetes), and may also have direct effects on biological processes such as inflammation.
- Kubzansky L.D.
- Davidson K.W.
- Rozanski A.
The clinical impact of negative psychological states: expanding the spectrum of risk for coronary artery disease.
Psychosom Med. 2005; 67: S10-S14
6Research in recent decades has increased the realization that the connection between depression and medical conditions like diabetes and cardiovascular disease poses a significant challenge for clinical and public health, particularly in an aging society.
- Mezuk B.
- Gallo J.J.
Depression and medical illness in late life: race, resources, and stress.
in: Lavretsky H. Sajatovic M. Reynolds C.F. Depression in Late Life. Oxford University Press, London2013: 270-294
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Geriatric Psychiatry
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states.Prev Chronic Dis. 2006; 3: 1-14
- Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction.Circulation. 2002; 105: 1049-1053
- Even minimal symptoms of depression increase mortality risk after acute myocardial infarction.[see comment].Am J Cardiol. 2001; 88: 337-341
- Depression without sadness: functional outcomes of nondysphoric depression in later life.J Am Geriatr Soc. 1997; 45: 570-578
- The clinical impact of negative psychological states: expanding the spectrum of risk for coronary artery disease.Psychosom Med. 2005; 67: S10-S14
- Depression and medical illness in late life: race, resources, and stress.in: Lavretsky H. Sajatovic M. Reynolds C.F. Depression in Late Life. Oxford University Press, London2013: 270-294
- Multimorbidity in older adults.Epidemiol Rev. 2013; 35: 75-83
- Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial.JAMA. 2004; 291: 1081-1091
- Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study.Am J Psychiatry. 2009; 166: 882-890
- Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care.BMJ. 2013; 346: f2570
- Does a depression management program decrease mortality in older adults with specific medical conditions in primary care? An exploratory analysis.J Am Geriatr Soc. 2016; 64: 126-131
- Multimorbidity, depression, and mortality in primary care: randomized clinical trial of an evidence-based depression care management program on mortality risk.J Gen Intern Med. 2016; 31: 380-386
- Prevention of post-stroke mortality using problem solving therapy or escitalopram.Am J Geriatr Psychiatry. 2017; 25: 512-519
- Improving depression and reducing cardiac events: which is the chicken and which is the egg?.J Psychosom Res. 2013; 74: 454-457
- No health without mental health.Lancet. 2007; 370: 859-877
Published online: February 10, 2017
© 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Prevention of Poststroke Mortality Using Problem-Solving Therapy or EscitalopramThe American Journal of Geriatric PsychiatryVol. 25Issue 5
- PreviewThis study re-examined patients from a 1-year randomized controlled double-blind trial of escitalopram, problem-solving therapy (PST), or placebo to prevent depression among patients less than 3 months after a stroke. The objective of the current study was to determine if preventive treatment would predict time to death over 8–10 years of follow-up. Based on the importance of depression in poststoke mortality and a previous study of this population at 18 months' follow-up showing that stopping escitalopram but not PST led to a significant increase in depression, the authors hypothesized that PST would be associated with the longest time to death.