Monday, 18 August 2003
This presentation is part of : Late-Life Mood Disorder: Significant Progress but Many Unanswered Questions

S013-003 Depression and Excess Mortality in Community Living Elderly: Which Mechanisms May Be Involved, and What Cues Can Be Obtained from Epidemiological Research?

Robert Schoevers1, Aartjan Beekman2, Mirjam I. Geerlings3, Dorly Deeg4, Cees Jonker2, and Willem Van Tilburg2. (1) psychiatry, Vrije Universiteit Amsterdam & Mentrum GGZ Amsterdam, Amsterdam, Netherlands, (2) psychiatry, GGZ Buitenamstel Vrije Universiteit, Amsterdam, Netherlands, (3) Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands, (4) Institute for Extramural Medicine, Vrije Universiteit Amsterdam, Amsterdam, Netherlands

Objective: Depression is expected to become the second leading cause of disability worldwide in 2020. Depression also appears to affect longevity. Both psychological and biological aspects of depression may be involved in the association between depression and excess mortality. Few studies have investigated whether severity, duration and specific symptom profiles of depression may be responsible for the elevated mortality risks. The current study attempts to do so.

Design: Longitudinal data will be presented from a large (n=4004) community study of older Amsterdam citizens (the Amsterdam Study of the Elderly), with baseline and three-year follow-up of depression using GMS-AGECAT, and a ten-year follow-up of community death registers.

Materials and Methods: Depression was subdivided according to duration (chronicity) and symptom severity. The 31 GMS depression items were also analysed separately, and clustered into four symptom profiles. The mortality risk of depression according to depression severity, duration and symptom characteristics was calculated using Cox regression models with adjustment for demographic variables, physical illness, cognitive decline and functional disabilities.

Results: Both moderate and severe depressions show a statistically significant association with excess mortality compared with subjects without depression. Subjects with chronic depression also have a significantly higher mortality risk. Depressed subjects with ‘negative thoughts’ or ‘autonomous dysregulation’ are more prone to die prematurely.

Conclusion: It is concluded that in the elderly, the risk of death associated with depression depends on severity, length of exposure and specific symptom profiles within the depression concept. The clinical and theoretical implications of these findings will be discussed.

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