title: Complex coevolution of depression and health-related quality of life in old age.
abstract: OBJECTIVE
  To investigate the coevolution of depression and health-related quality of life (HRQoL) in old age.
  
  
  METHODS
  In a representative survey of the German general population aged 75 years and older, the course of HRQoL and depression was observed over 4.5 years (3 waves). HRQoL was assessed by the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, while the Geriatric Depression Scale was used to measure depression. A panel vector autoregressive model was used to account for the complex coevolution of depression and HRQoL. Unobserved heterogeneity was taken into account by taking the first differences.
  
  
  RESULTS
  We revealed a robust negative association between an initial change in HRQoL and a subsequent change in depression score, with substantial sex differences: In women there was a robust association, while in men the significance of this association depended on the model specification. Surprisingly, in the total sample and in both sexes, no robust association between an initial increase in depression and a subsequent change in HRQoL was found.
  
  
  CONCLUSIONS
  Findings indicate that the direction of evolution from HRQoL to depression deserves more attention. Furthermore, treatment of depression in late life should aim at improving HRQoL in which remission of depressive symptoms is necessary but not sufficient.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. a.hajek@uke.de.
authors.forename: André
authors.initials: A
authors.lastname: Hajek
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brettschneider
authors.affiliation: Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Ernst
authors.affiliation: Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Lange
authors.affiliation: Institute of General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.affiliation: Institute of General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Prokein
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Werle
authors.affiliation: Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Pentzek
authors.affiliation: Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Stein
authors.affiliation: Department of Psychiatry, Technical University of Munich, Arcisstr. 21, 80333, Munich, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.affiliation: Department of Psychiatry, Technical University of Munich, Arcisstr. 21, 80333, Munich, Germany.
authors.forename: Edelgard
authors.initials: E
authors.lastname: Mösch
authors.affiliation: Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Heser
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.|German Center for Neurodegenerative Diseases, Ludwig-Erhard-Allee 2, 53175, Bonn, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Jessen
authors.affiliation: Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.|German Center for Neurodegenerative Diseases, Ludwig-Erhard-Allee 2, 53175, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology*
keywords: Depression; Depressive symptoms; Health-related quality of life; Longitudinal studies; Older people; Vector autoregressive model