title: [Depression and the risk of long-term care insurance certification: the Tsurugaya project].
abstract: OBJECTIVE
  The purpose of this study was to examine the relationship between depressive status and subsequent certification of long-term care insurance use, and to investigate sex differences in this relationship in an elderly Japanese population.
  
  
  METHODS
  The Tsurugaya Project was a comprehensive geriatric assessment conducted for community-dwelling elderly persons aged 70 years or older in the Tsurugaya area, Sendai, Japan (N = 2,925). Of those who participated (N = 958), the 841 who gave informed consent and were not qualified for certification of long-term care insurance use at the baseline survey were analyzed. Depression was asessed using the 30-item Geriatric Depression Scale (GDS). We classified the subjects into three categories: normal (GDS less than 10), mild depression (GDS between 10 and 13), and moderate to severe depression (GDS more than 13 and/or taking antidepressive medication). The hazard ratio of incident certification of long-term care insurance use by depressive status was calculated using the Cox proportional hazards model.
  
  
  RESULTS
  During 4 years of follow-up, a total of 151 subjects were certificated for long-term care insurance and 46 subjects died. Particularly in men, the depressive status was related to subsequent incident certification of long-term care insurance use. In men, the age-adjusted hazard ratios (HRs) were 1.77 (95% confidence interval (CI): 0.91-3.48) for mild depression, and 2.26 (1.11-4.64) for moderate to severe depression (P for trend = 0.023). The relationship between depressive status and subsequent certification of long-term care insurance use in men was significant even after adjustment for age, comorbid conditions, social factors and lifestyle (multivariate-adjusted HR: 1.31 (95% CI: 0.65-2.65); mild depression 2.19 (1.06-4.54); moderate to severe depression: P for trend= 0.034). In women, there was no significant association between depressive status and certification of long-term care insurance use. In both sexes, there was no significant association between depressive status and death.
  
  
  CONCLUSIONS
  The relationship between depressive status and subsequent certification of long-term care insurance use was significant only in men. In men, the relationship was significant even after adjustment for age, comorbid conditions, social factors and lifestyle. These results suggest a sex difference in the relationship between depressive status and subsequent certification of long-term care insurance use in elderly Japanese.
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine.
authors.forename: Kaori
authors.initials: K
authors.lastname: Ohmori-Matsuda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Sone
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Koizumi-Masamune
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakaya
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kuriyama
authors.forename: Syuji
authors.initials: S
authors.lastname: Suzuki
authors.forename: Shuichi
authors.initials: S
authors.lastname: Awata
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003863:Depression; D005260:Female; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D008297:Male; D009313:National Health Programs; D012737:Sex Factors