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Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

Published online by Cambridge University Press:  11 April 2012

E. Scafato ,
L. Galluzzo ,
S. Ghirini ,
C. Gandin ,
A. Rossi ,
V. Solfrizzi ,
F. Panza ,
A. Di Carlo ,
S. Maggi  and
G. Farchi
E. Scafato
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
L. Galluzzo*
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
S. Ghirini
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
C. Gandin
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
A. Rossi
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
V. Solfrizzi
Affiliation:
Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Italy
F. Panza
Affiliation:
Geriatric Unit and Gerontology–Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
A. Di Carlo
Affiliation:
Department of Neurological Sciences, University of Florence and Institute of Neuroscience, National Research Council of Italy (CNR), Firenze, Italy
S. Maggi
Affiliation:
Institute of Neuroscience, National Research Council of Italy (CNR), Padova, Italy
G. Farchi
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
*
*Address for correspondence: Dr L. Galluzzo, Reparto Salute Popolazione e suoi Determinanti, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore di Sanità (ISS), Via Giano della Bella 34, 00161 Rome, Italy. (Email: [email protected])
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Abstract

Background

Depression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.

Method

As part of a prospective, population-based study on a random sample of 5632 subjects aged 65–84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.

Results

Severity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15–1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32–0.95; men MHR 0.59, 95% CI 0.37–0.93). Neither sociodemographic nor medical confounders significantly modified these associations.

Conclusions

Consistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

Keywords

Depressionelderlyepidemiologymortality
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 12 , December 2012 , pp. 2619 - 2629
Copyright
Copyright © Cambridge University Press 2012

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References

Anstey, KJ, Luszcz, MA (2002). Mortality risk varies according to gender and change in depressive status in very old adults. Psychosomatic Medicine 64, 880–888.Google ScholarPubMed
Barry, LC, Allore, HG, Guo, Z, Bruce, ML, Gill, TM (2008). Higher burden of depression among older women: the effect of onset, persistence, and mortality over time. Archives of General Psychiatry 65, 172–178.CrossRefGoogle ScholarPubMed
Bogner, HR, Morales, KH, Reynolds, CF 3rd, Cary, MS, Bruce, ML (2011). Course of depression and mortality among older primary care patients. American Journal of Geriatric Psychiatry. Published online 12 October 2011. doi:10.1097/JGP.0b013e3182331104.Google Scholar
Brink, TL, Yesavage, JA, Lum, O, Heersema, PH, Adey, M, Rose, TL (1982). Screening tests for geriatric depression. Clinical Gerontologist 1, 37–44.CrossRefGoogle Scholar
Cole, MG, Dendukuri, N (2003). Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry 160, 1147–1156.CrossRefGoogle ScholarPubMed
Copeland, JR, Beekman, AT, Braam, AW, Dewey, ME, Delespaul, P, Fuhrer, R, Hooijer, C, Lawlor, BA, Kivela, SL, Lobo, A, Magnusson, H, Mann, AH, Meller, I, Prince, MJ, Reischies, F, Roelands, M, Skoog, I, Turrina, C, deVries, MW, Wilson, KC (2004). Depression among older people in Europe: the EURODEP studies. World Psychiatry 3, 45–49.Google ScholarPubMed
Dalle Carbonare, L, Maggi, S, Noale, M, Giannini, S, Rozzini, R, Lo Cascio, V, Crepaldi, G; the ILSA Working Group (2009). Physical disability and depressive symptomatology in an elderly population: a complex relationship. The Italian Longitudinal Study on Aging (ILSA). American Journal of Geriatric Psychiatry 17, 144–154.CrossRefGoogle Scholar
Djernes, JK (2006). Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatrica Scandinavica 113, 372–387.CrossRefGoogle ScholarPubMed
Folstein, MF, Folstein, SE, McHugh, PR (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Geerlings, SW, Beekman, AT, Deeg, DJ, Twisk, JW, Van Tilburg, W (2002). Duration and severity of depression predict mortality in older adults in the community. Psychological Medicine 32, 609–618.CrossRefGoogle ScholarPubMed
Gelenberg, A (1999). Depression is still underrecognized and undertreated. Archives of Internal Medicine 159, 1657–1658.CrossRefGoogle ScholarPubMed
Giese-Davis, J, Collie, K, Rancourt, KMS, Neri, E, Kraemer, HC, Spiegel, D (2011). Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. Journal of Clinical Oncology 29, 413–420.CrossRefGoogle ScholarPubMed
ILSA (1997). Prevalence of chronic diseases in older Italians: comparing self-reported and clinical diagnoses. The Italian Longitudinal Study on Aging Working Group. International Journal of Epidemiology 26, 995–1002.CrossRefGoogle Scholar
Kalbfleisch, JD, Prentice, RL (1980). The Statistical Analysis of Failure Time Data. John Wiley & Sons: New York.Google Scholar
Katz, S, Downs, TD, Cash, HR, Grotz, RC (1970). Progress in development of the index of ADL. The Gerontologist 10, 20–30.CrossRefGoogle ScholarPubMed
Lawton, MP, Brody, EM (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist 9, 179–186.CrossRefGoogle ScholarPubMed
Maggi, S, Zucchetto, M, Grigoletto, F, Baldereschi, M, Candelise, L, Scarpini, E, Scarlato, G, Amaducci, L (1994). The Italian Longitudinal Study on Aging (ILSA): design and methods. Aging Clinical and Experimental Research 6, 464–473.CrossRefGoogle ScholarPubMed
Marzari, C, Maggi, S, Manzato, E, Destro, C, Noale, M, Bianchi, D, Minicuci, N, Farchi, G, Baldereschi, M, Di Carlo, A, Crepaldi, G; the ILSA Working Group (2005). Depressive symptoms and development of coronary heart disease events: the Italian Longitudinal Study on Aging. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 60, 85–92.CrossRefGoogle ScholarPubMed
Minicuci, N, Maggi, S, Pavan, M, Enzi, G, Crepaldi, G (2002). Prevalence rate and correlates of depressive symptoms in older individual: the Veneto Study. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 57, M155–M161.CrossRefGoogle ScholarPubMed
Penninx, BW, Guralnik, JM, Mendes de Leon, CF, Pahor, M, Visser, M, Corti, MC, Wallace, RB (1998). Cardiovascular events and mortality in newly and chronically depressed persons >70 years of age. American Journal of Cardiology 81, 988–994.CrossRefGoogle Scholar
Pulska, T, Pahkala, K, Laippala, P, Kivelä, SL (1999). Follow up study of longstanding depression as predictor of mortality in elderly people living in the community. British Medical Journal 318, 432–433.CrossRefGoogle ScholarPubMed
Rozzini, R, Sabatini, T, Frisoni, GB, Trabucchi, M (2001). Association between depressive symptoms and mortality in elderly people. Archives of Internal Medicine 161, 299–300.CrossRefGoogle ScholarPubMed
Rozzini, R, Sabatini, T, Frisoni, GB, Trabucchi, M (2002). Depressive symptoms and negative outcomes in older hospitalized patients. Archives of Internal Medicine 162, 948–949.CrossRefGoogle ScholarPubMed
Saz, P, Dewey, ME (2001). Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature. International Journal of Geriatric Psychiatry 16, 622–630.CrossRefGoogle ScholarPubMed
Scafato, E, Galluzzo, L, Gandin, C, Ghirini, S, Baldereschi, M, Capurso, A, Maggi, S, Farchi, G; for the ILSA Working Group (2008). Marital and cohabitation status as predictors of mortality: a ten-year follow-up of an Italian elderly cohort. Social Science and Medicine 67, 1456–1464.CrossRefGoogle Scholar
Schoevers, RA, Geerlings, MI, Deeg, DJ, Holwerda, TJ, Jonker, C, Beekman, AT (2009). Depression and excess mortality: evidence for a dose response relation in community living elderly. International Journal of Geriatric Psychiatry 24, 169–176.CrossRefGoogle ScholarPubMed
Schulz, R, Beach, SR, Ives, DG, Martire, LM, Ariyo, AA, Kop, WJ (2000). Association between depression and mortality in older adults: the Cardiovascular Health Study. Archives of Internal Medicine 160, 1761–1768.CrossRefGoogle ScholarPubMed
Schulz, R, Drayer, RA, Rollman, BL (2002). Depression as a risk factor for non-suicide mortality in the elderly. Biological Psychiatry 52, 205–225.CrossRefGoogle ScholarPubMed
St John, PD, Montgomery, PR (2009). Do depressive symptoms predict mortality in older people? Aging and Mental Health 13, 674–681.CrossRefGoogle ScholarPubMed
Wulsin, LR, Vaillant, GE, Wells, VE (1999). A systematic review of the mortality of depression. Psychosomatic Medicine 61, 6–17.CrossRefGoogle ScholarPubMed
Zhang, JP, Kahana, B, Kahana, E, Hu, B, Pozuelo, L (2009). Joint modeling of longitudinal changes in depressive symptoms and mortality in a sample of community-dwelling elderly people. Psychosomatic Medicine 71, 704–714.CrossRefGoogle Scholar