Increased depressive symptoms associated with increased mortality

January 01, 0001

Increased depressive symptoms associated with increased mortality

Depression is associated with increased mortality, but it is unclear if this relationship is dose-dependent and if it can be modified by treatment with antidepressants. The aim of this study by researchers from Western Australia was to determine if (1) the association between depression and mortality is independent of other common potential causes of death in later life, (2) there is a dose-response relationship between increasing severity of depression and mortality rates, and (3) the use of antidepressant drugs reduces mortality rates. They conducted a cohort study of 5,276 community-dwelling men aged 68-88 years living in Perth, Australia. They used the Geriatric Depression Scale 15-items (GDS-15) to ascertain the presence and severity of depression. GDS-15=7 indicates the presence of clinically significant depression. Men were also grouped according to the severity of symptoms: "no symptoms" (GDS-15 = 0), "questionable" (1=GDS-15=4), "mild to moderate" (5=GDS-15=9), and "severe" (GDS-15=10). Participants listed all medications used regularly.

There were 883 deaths between the study assessment and the 30th June 2008 (mean follow-up of participants: 6.0 years). The adjusted mortality hazard (MH) of men with clinically significant depression was 1.98 and increased with the severity of symptoms: 1.39 for questionable, 2.71 for mild/moderate, and 3.32 for severe depression. The use of antidepressants increased MH (HR = 1.31). Compared with men who were not depressed and were not taking antidepressants, MH increased from 1.22 for men with no depression who were using antidepressants to 1.85 for participants who were depressed but were not using antidepressants, and 2.97 for those who were depressed and were using antidepressants. All analyses were adjusted for age, educational attainment, migrant status, physical activity, smoking and alcohol use and a comorbidity index.

The researchers concluded: "The mortality associated with depression increases with the severity of depressive symptoms and is largely independent of comorbid conditions. The use of antidepressants does not reduce the mortality rates of older men with persistent symptoms of depression."

This is a reminder not to forget the physical health of people with depression, despite no link to comorbid conditions. Were they known?

For the full abstract, click here.

PLoS ONE 5(6):e11266 23 June 2010 © 2010 Almeida et al
Depression, Antidepressant Use and Mortality in Later Life: The Health in Men Study. Osvaldo P. Almeida, Helman Alfonso, Graeme J. Hankey and Leon Flicker. Correspondence to Osvaldo Almeida: [email protected]

Category: P. Psychological. Keywords: depression, antidepressant, use, mortality, later life, men, cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 23 July 2010

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