title: Associations between depression and all-cause and cause-specific risk of death: a retrospective cohort study in the Veterans Health Administration.
abstract: OBJECTIVE
  Depression may be associated with increased mortality risk, but there are substantial limitations to existing studies assessing this relationship. We sought to overcome limitations of existing studies by conducting a large, national, longitudinal study to assess the impact of depression on all-cause and cause-specific risk of death.
  
  
  METHODS
  We used Cox regression models to estimate hazard ratios associated with baseline depression diagnosis (N=849,474) and three-year mortality among 5,078,082 patients treated in Veterans Health Administration (VHA) settings in fiscal year (FY) 2006. Cause of death was obtained from the National Death Index (NDI).
  
  
  RESULTS
  Baseline depression was associated with 17% greater hazard of all-cause three-year mortality (95% CI hazard ratio [HR]: 1.15, 1.18) after adjusting for baseline patient demographic and clinical characteristics and VHA facility characteristics. Depression was associated with a higher hazard of three-year mortality from heart disease, respiratory illness, cerebrovascular disease, accidents, diabetes, nephritis, influenza, Alzheimer's disease, septicemia, suicide, Parkinson's disease, and hypertension. Depression was associated with a lower hazard of death from malignant neoplasm and liver disease. Depression was not associated with mortality due to assault.
  
  
  CONCLUSIONS
  In addition to being associated with suicide and injury-related causes of death, depression is associated with increased risk of death from nearly all major medical causes, independent of multiple major risk factors. Findings highlight the need to better understand and prevent mortality seen with multiple medical disorders associated with depression.
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, United States; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States; Institute for Social Research, University of Michigan, Ann Arbor, MI, United States. Electronic address: kzivin@umich.edu.
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States.
authors.forename: Matheos
authors.initials: M
authors.lastname: Yosef
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Miller
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, United States; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States.
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, United States; University of Michigan School of Nursing, Ann Arbor, MI, United States.
authors.forename: Sonia
authors.initials: S
authors.lastname: Duffy
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, United States; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Kales
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, United States; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States.
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D003863:Depression / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Depression; Mortality; Risk of death; Veterans