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Mortality Risk Varies According to Gender and Change in Depressive Status in Very Old Adults

From the Centre for Mental Health Research, Australian National University (K.J.A.), Canberra, Australian Capital Territory, Australia; and the School of Psychology and Centre for Ageing Studies, Flinders University (M.A.L.), Adelaide, South Australia.

Address reprint requests to: Kaarin Anstey, Centre for Mental Health Research, Australian National University, Canberra ACT 0200, Australia. Email: kaarin.anstey{at}anu.edu.au

OBJECTIVE: We aimed to evaluate whether gender and different patterns of change in depressive status over 2 years were associated with different risks of mortality in the subsequent 6 years.

METHODS: Depression (CES-D) was assessed in 1947 participants in 1992 and a smaller proportion of the sample in 1994. The mortality risk at July 30, 2000, associated with depression and change in depression was estimated using proportional hazards models.

RESULTS: After controlling for demographic variables, smoking, alcohol, and medical conditions, depression was associated with mortality for men but not women. In men, incident depression was associated with mortality after controlling for all other variables. Chronic depression and remitted depression were also associated with mortality, but this effect was explained by medical conditions. In women, change in depressive status was not associated with mortality.

CONCLUSIONS: Depression confers a greater risk of mortality for men than women with incident depression in old age representing the greatest risk for men. The course of depressive illness must be considered when evaluating mortality risk.

Key Words: depression, • mortality, • longitudinal study, • aging, • sex differences.

Abbreviations: BMI = body mass index;; CES-D = Center for Epidemiological Studies Depression Scale;; CVD = cardiovascular disease;; IRR = incident rate ratio.

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