Does depression in old age increase only cardiovascular mortality? The Leiden 85-plus Study.
BACKGROUND
Depression in old age is associated with an increased mortality risk of cardiovascular disease but the mortality risk from non-cardiovascular causes is disputed.


OBJECTIVE
To investigate the effect of depression on cardiovascular and non-cardiovascular mortality in old age.


METHODS
We prospectively followed 500 subjects from age 85 years onwards within the population-based Leiden 85-plus Study. Depressive symptoms were assessed annually with the 15-item Geriatric Depression Scale (GDS-15). Mortality risks were estimated in a Cox proportional-hazards model with the annual assessment of depression (GDS-15> or =4 points) as a time-dependent covariate.


RESULTS
During 1654 person-years of follow-up (mean per person, 3.2 years), depression was associated with a two-fold increase of all cause mortality [Relative Risk (RR), 1.83; 95% Confidence Interval (CI), 1.24-2.69] that was not explained by comorbid conditions. Both cardiovascular mortality and non-cardiovascular mortality contributed equally to the excess mortality (RR 1.95 and 1.75 respectively).


CONCLUSIONS
Depression in old age contributes to an increase of both cardiovascular and non-cardiovascular mortality. Motivational depletion may play an important role in the increased mortality in elderly with depression.
Vinkers
David J
DJ
Department of General Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands. d.j.vinkers@lumc.nl
Stek
Max L
ML
Gussekloo
Jacobijn
J
Van Der Mast
Roos C
RC
Westendorp
Rudi G J
RG
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000523:psychology; D003863:Depression / Q000150:complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors