Low Hemoglobin Levels and Risk of Developing Depression in the Elderly: Results From the Prospective PRO.V.A. Study.
OBJECTIVE
Low hemoglobin negatively affects health in the elderly, but research about the association with risk for depression is limited. We investigated the association between baseline hemoglobin concentrations and incident depression in a cohort of nondepressed elderly individuals.


METHODS
As part of the Northern Italian Progetto Veneto Anziani (PRO.V.A.) study, randomly drawn, community-dwelling subjects aged ≥ 65 years underwent prospective clinical and laboratory assessments between October 1995 and December 2002. The association between baseline hemoglobin and depression was assessed with adjusted Cox regression analyses. Baseline serum hemoglobin concentrations were further categorized in gender-specific tertiles; anemia was defined as serum hemoglobin < 13 g/dL for men and < 12 g/dL for women. Moreover, hemoglobin concentration was measured at follow-up, and changes in concentration from baseline to follow-up were investigated. Depression was defined by a score of ≥ 11/30 on the validated Geriatric Depression Scale and confirmed by psychogeriatric specialists.


RESULTS
Among 1,303 elderly individuals (566 men, 737 women) without depression at baseline, 294 subjects (177 women, 117 men; global incidence rate = 50 [95% confidence interval (CI), 0-170] per 1,000 patient years) developed depression during 4.4 years of follow-up. Low baseline serum hemoglobin concentration was most strongly associated with incident depression at follow-up in men (hazard ratio [HR] = 1.39; 95% CI, 1.12-1.69; P = .002), but not in women (P = .50). Men with the lowest baseline tertile hemoglobin concentration (HR = 1.68; 95% CI, = 1.02-3.08; P = .04) or with anemia (HR = 2.02; 95% CI, = 1.13-3.64; P = .02) had greater risk of depression, whereas findings were nonsignificant for women. Low follow-up hemoglobin concentration in men was less strongly associated with incident depression (HR = 1.15; 95% CI, 1.01-1.33; P = .05), as were the lowest endpoint tertile hemoglobin concentration (P = .03) and presence of anemia (P = .05).


CONCLUSIONS
Low baseline hemoglobin strongly predicted incident depression in older men, but not in women.​.
Department of Medicine-DIMED, Geriatrics Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy. skicateg@libero.it.|Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
Caterina
C
Trevisan
Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
Nicola
N
Veronese
Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
Francesco
F
Bolzetta
Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
Marina
M
De Rui
The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York, USA.|Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.|Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, New York, USA.|Department of Psychiatry and Behaviroal Sciences, Albert Einstein College of Medicine, Bronx, New York, USA.
Christoph U
CU
Correll
The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York, USA.|Aging Branch, National Research Council, Neuroscience Institute, Padova, Italy.
Sabina
S
Zambon
Department of Medicine DIMED, Clinica Medica I, University of Padova, Italy.
Estella
E
Musacchio
Department of Medicine DIMED, Clinica Medica I, University of Padova, Italy.
Leonardo
L
Sartori
Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit, University of Padova, Italy.
Egle
E
Perissinotto
Aging Branch, National Research Council, Neuroscience Institute, Padova, Italy.
Gaetano
G
Crepaldi
Department of Neurosciences, University of Padova, Italy.
Marco
M
Solmi
Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.|Aging Branch, National Research Council, Neuroscience Institute, Padova, Italy.
Enzo
E
Manzato
Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
Giuseppe
G
Sergi
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood* / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D012306:Risk; D012737:Sex Factors
D006454:Hemoglobins