title: Association between depression and mortality in older adults: the Cardiovascular Health Study.
abstract: BACKGROUND
  Studies of the association between depressive symptoms and mortality in elderly populations have yielded contradictory findings. To address these discrepancies, we test this association using the most extensive array of sociodemographic and physical health control variables ever studied, to our knowledge, in a large population-based sample of elderly individuals.
  
  
  OBJECTIVE
  To examine the relation between baseline depressive symptoms and 6-year all-cause mortality in older persons, systematically controlling for sociodemographic factors, clinical disease, subclinical disease, and health risk factors.
  
  
  METHODS
  A total of 5201 men and women aged 65 years and older from 4 US communities participated in the study. Depressive symptoms and 4 categories of covariates were assessed at baseline. The primary outcome measure was 6-year mortality.
  
  
  RESULTS
  Of the 5201 participants, 984 (18.9%) died within 6 years. High baseline depressive symptoms were associated with a higher mortality rate (23.9%) than low baseline depression scores (17.7%) (unadjusted relative risk [RR], 1.41; 95% confidence interval [CI], 1.22-1.63). Depression was also an independent predictor of mortality when controlling for sociodemographic factors (RR, 1.43; 95% CI, 1.23-1.66), prevalent clinical disease (RR, 1.25; 95% CI, 1.07-1.45), subclinical disease indicators (RR, 1.35; 95% CI, 1.15-1.58), or biological or behavioral risk factors (RR, 1.42; 95% CI, 1.22-1.65). When the best predictors from all 4 classes of variables were included as covariates, high depressive symptoms remained an independent predictor of mortality (RR, 1.24; 95% CI, 1.06-1.46).
  
  
  CONCLUSIONS
  High levels of depressive symptoms are an independent risk factor for mortality in community-residing older adults. Motivational depletion may be a key underlying mechanism for the depression-mortality effect.
authors.affiliation: Department of Psychiatry, The University Center for Social and Urban Research, University of Pittsburgh, PA 15260, USA. schulz+@pitt.edu
authors.forename: R
authors.initials: R
authors.lastname: Schulz
authors.forename: S R
authors.initials: SR
authors.lastname: Beach
authors.forename: D G
authors.initials: DG
authors.lastname: Ives
authors.forename: L M
authors.initials: LM
authors.lastname: Martire
authors.forename: A A
authors.initials: AA
authors.lastname: Ariyo
authors.forename: W J
authors.initials: WJ
authors.lastname: Kop
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D003863:Depression / Q000401:mortality*; D003866:Depressive Disorder / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009042:Motivation; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology