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From the Consultation-Liaison Service, Department of Psychiatry (S.L.S.), and Department of Medicine (H.P.H.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Purdue Pharma (R.D.), Stamford, Connecticut.
Address reprint requests to: Stephen L. Stern, MD, Department of Psychiatry, Mail Code 7792, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900. Email: sterns{at}uthscsa.edu
OBJECTIVE: The purpose of this study was to evaluate the relationship between hopelessness and mortality in a biethnic cohort of older community-dwelling Mexican Americans, the most rapidly growing segment of the elderly, and European Americans.
METHODS: A total of 795 persons aged 64 to 79 years completed an English or Spanish version of the 30-item Geriatric Depression Scale on entering the San Antonio Longitudinal Study of Aging, an epidemiologic survey, between 1992 and 1996. Women constituted 58% and Mexican Americans 54% of this randomly selected sample. Subjects who answered "no" to the item "Are you hopeful about the future?" were classified as hopeless.
RESULTS: As of August 1999, 29% of the 73 hopeless subjects had died, compared with 11% of the hopeful, a highly significant difference. The mortality rates for cardiovascular disease and cancer were significantly greater among the hopeless subjects (7%) than among the hopeful (3%). Hopelessness predicted all-cause mortality in a Cox proportional hazards model adjusted for age, ethnic background, current smoking status, number of comorbid medical conditions, self-rated health, and frequency of social contacts (risk ratio = 2.23, 95% confidence interval = 1.33 to 3.76, p = .0026). Neither sex nor probable depression was a significant predictor of mortality in this model.
CONCLUSION: These findings, together with those of others, suggest that hopelessness is a significant predictor of mortality in older and middle-aged adults of various ethnic backgrounds. Further research is needed to evaluate the mechanisms that underlie this phenomenon and the effects of treating hopelessness on the quality and duration of subjects’ lives.
Key Words: hopelessness • Mexican American • European American • mortality • cardiovascular disease • cancer.
Abbreviations: CI = confidence interval; EA = European American; GDS = Geriatric Depression Scale; HBA = home-based assessment; LOT = Life Orientation Test; MA = Mexican American; SAHS = San Antonio Heart Study; SALSA = San Antonio Longitudinal Study of Aging.
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