title: Survival rate and causes of mortality in the elderly with depression: a 15-year prospective study of a Japanese community sample, the Matsunoyama-Niigata suicide prevention project.
abstract: OBJECTIVE
  To compare long-term survival rates and causes of death in community-dwelling elderly with and without depression using the International Research Diagnostic Criteria administered by a psychiatrist.
  
  
  METHODS
  From 1985 to 2000, we prospectively examined Japanese persons (N = 920) aged 65 years or older. Cases with depression (n = 158) and a control sample without depression (N = 762) were evaluated. The main outcome variables were survival rates and causes of mortality.
  
  
  RESULTS
  By 2000, 61% of the subjects with depression had died. By contrast, 48% had died in the control group at the completion of the 15-year follow-up. Using age-adjusted Kaplan-Meier survival analysis, we found a hazard ratio (HR) of 1.49 (95% confidence interval [CI] 1.16-1.89) for mortality in the depressed group compared with controls (p = .0009). Importantly, in female subjects with depression, the HR was 1.55 (95% CI 1.16-2.07; p = .002). In males with depression, by contrast, the HR (1.34) was not significant (95% CI 0.84-2.13; p = .19). Significantly more subjects died of cerebrovascular disorders, malignant tumors, respiratory disorders, or suicide after the onset of depression compared with controls (p < .05).
  
  
  CONCLUSIONS
  Depression appears to be associated with a significant increase in the risk of mortality among elderly Japanese subjects, particularly in females. The elderly with a diagnosis of depression may be at an elevated risk of mortality owing to cerebrovascular disorder, malignant tumors, respiratory disorders, or suicide. These prospective data provide a new quantitative insight on gender differences and the long-term public health significance of depression among the community-dwelling elderly.
authors.affiliation: Department of Psychiatry, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Toshiki
authors.initials: T
authors.lastname: Shioiri
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Takahashi
authors.forename: Vural
authors.initials: V
authors.lastname: Ozdemir
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Someya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000150:complications / Q000401:mortality; D003866:Depressive Disorder / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000401:mortality; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012140:Respiratory Tract Diseases / Q000150:complications / Q000401:mortality; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data; D015996:Survival Rate