Depression, cardiovascular disease, diabetes, and two-year mortality among older, primary-care patients.
OBJECTIVE
Depression is a major contributor to death and disability, but few follow-up studies of depression have been carried out in the primary-care setting. The authors sought to assess whether depression in older patients is associated with increased mortality after a 2-year follow-up interval and to estimate the population-attributable fraction (PAF) of depression on mortality in older primary-care patients.


METHODS
Longitudinal cohort analysis was carried out in 20 primary-care practices. Participants were identified though a two-stage, age-stratified (60-74 or 75+) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of screened-negative patients. In all, 1,226 persons were assessed at baseline. Vital status at 2 years was the outcome of interest.


RESULTS
Of 1,226 persons in the sample, 598 were classified as depressed. After 2 years, 64 persons had died. Persons with depression at baseline were more likely to die at the end of the 2-year follow-up interval than were persons without depression, even after accounting for potentially influential covariates such as whether the participant reported a history of myocardial infarction (MI) or diabetes.


CONCLUSIONS
Among older, primary-care patients over the course of a 2-year follow-up interval, depression contributed as much to mortality as did MI or diabetes.
Gallo
Joseph J
JJ
Dept. of Family Practice and Community Medicine, School of Medicine, University of Pennsylvania, 3400 Spruce Street, 2 Gates Bldg., Philadelphia, PA 19104, USA. galloj@uphs.upenn.edu
Bogner
Hillary R
HR
Morales
Knashawn H
KH
Post
Edward P
EP
Ten Have
Thomas
T
Bruce
Martha L
ML
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D015984:Causality; D002423:Cause of Death; D015897:Comorbidity; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012494:Sampling Studies; D016019:Survival Analysis