Depressive Trajectories and Risk of Disability and Mortality in Older Adults: Longitudinal Findings From the Health, Aging, and Body Composition Study.
BACKGROUND
Depression and disability are closely linked. Less is known regarding clinical and subclinical depressive symptoms over time and risk of disability and mortality.


METHODS
Responses to the Center for Epidemiologic Studies Short Depression scale (CES-D10) were assessed over a 4-year period in men (n = 1032) and women (n = 1070) aged 70-79 years initially free from disability. Depressive symptom trajectories were defined with group-based models. Disability (2 consecutive reports of severe difficulty walking one-quarter mile or climbing 10 steps) and mortality were determined for 9 subsequent years. Hazard ratios (HRs) were estimated using Cox proportional hazards adjusted for covariates.


RESULTS
Three trajectories were identified: persistently nondepressed (54% of men, 54% of women, mean baseline CES-D10: 1.16 and 1.46), mildly depressed and increasing (40% of men, 38% of women, mean baseline CES-D10: 3.60 and 4.35), and depressed and increasing (6% of men, 8% of women, mean baseline CES-D10: 7.44 and 9.61). Disability and mortality rates per 1,000 person years were 41.4 and 60.3 in men and 45.8 and 41.9 in women. Relative to nondepressed, men in the mildly depressed (HR = 1.45, 95% confidence interval [CI] 1.11-1.89) and depressed trajectories (HR = 2.12, 95% CI 1.33-3.38) had increased disability; women in the depressed trajectory had increased disability (HR = 2.02, 95% CI 1.37-2.96). Men in the mildly depressed (HR = 1.24, 95% CI 1.01-1.52) and depressed trajectories (HR = 1.63, 95% CI 1.10-2.41) had elevated mortality risk; women exhibited no mortality risk.


CONCLUSIONS
Trajectories of depressive symptoms without recovery may predict disability and mortality in apparently healthy older populations, thus underscoring the importance of monitoring depressive symptoms in geriatric care.
School of Population and Public Health, University of British Columbia, Vancouver, Canada. Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland. rachel.murphy@ubc.ca.
Rachel A
RA
Murphy
School of Human Evolution and Social Change, Arizona State University, Tempe.
Ashley K
AK
Hagaman
Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland. Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands.
Ilse
I
Reinders
Cancer Prevention Fellowship Program, National Cancer Institute/Division of Cancer Control and Population Sciences, Rockville, Maryland.
Jeremy A
JA
Steeves
Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pennsylvania.
Anne B
AB
Newman
Department of Psychiatry, University of California at San Francisco.
Susan M
SM
Rubin
Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis.
Suzanne
S
Satterfield
Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina.
Stephen B
SB
Kritchevsky
Department of Psychiatry, University of California at San Francisco.
Kristine
K
Yaffe
Department of Psychiatry, University of California at San Francisco.
Hilsa N
HN
Ayonayon
Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania.
Daniel S
DS
Nagin
Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland.
Eleanor M
EM
Simonsick
Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Brenda W J H
BW
Penninx
Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland.
Tamara B
TB
Harris
D000368:Aged; D003863:Depression / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
Aging; Depression; Function; Geriatric; Mood