Psychotic depression and mortality.
OBJECTIVE
Major depressive disorder is associated with elevated mortality rates that increase with the severity of depression. The authors hypothesized that patients with psychotic depression would have higher mortality rates than patients with nonpsychotic depression.


METHODS
Survival analytic techniques were used to compare the vital status of 61 patients with psychotic major depression with that of 59 patients with nonpsychotic major depression up to 15 years after hospital admission. Medical status was assessed with the Cumulative Illness Rating Scale. Dexamethasone suppression test (DST) data were available for 101 patients.


RESULTS
The mortality rate for subjects with psychotic depression was significantly greater than that for those with nonpsychotic depression, with 41% versus 20%, respectively, dying within 15 years after hospital admission. A proportional hazards model with age and medical status entered as covariates confirmed a significantly higher mortality rate in patients with psychotic depression (hazards ratio=2.31). A positive DST result was associated with psychotic depression but was not related to vital status.


CONCLUSIONS
Patients with psychotic depression have a two-fold greater risk of death than do patients with severe, nonpsychotic major depression.
Vythilingam
Meena
M
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. meena.vythi@nih.gov
Chen
Joyce
J
Bremner
J Douglas
JD
Mazure
Carolyn M
CM
Maciejewski
Paul K
PK
Nelson
J Craig
JC
D000341:Affective Disorders, Psychotic / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D003866:Depressive Disorder / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D003907:Dexamethasone; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis
D003907:Dexamethasone; D006854:Hydrocortisone