Objective To investigate the association between depression and mortality in the elderly living in low‐ and middle‐income countries. Methods A systematic review and meta‐analysis was performed. We searched in five electronic databases for observational studies investigating the association between mortality and depression. Two reviewers worked independently to select articles, extract data, and assess study quality. Results A total of 10 studies including 13 828 participants (2402 depressed and 11 426 nondepressed) from six countries (Brazil, four articles; China, two articles; Botswana, India, South Africa, and South Korea, one article) were included. The overall unadjusted relative risk (RR) of mortality in depressed relative to nondepressed participants was 1.62 (95% CI, 1.39‐1.88; P < 0.001), with high heterogeneity (I2 = 66%; 95% CI, 33‐83; P < 0.005). After adjustment for publication bias, the overall RR decreased to 1.60 (95% CI, 1.37‐1.86; P < 0.001). No significant differences were observed between subgroups except those defined by study quality. The high‐quality studies had a pooled RR of 1.48 (95% CI, 1.32‐1.67; P < 0.001), while the low‐quality studies resulted had a pooled RR of 1.82 (95% CI, 1.25‐2.65; P < 0.005). Conclusions Depression is associated with excess mortality in the elderly living in low‐ and middle‐income countries. In addition, this excess mortality does not differ substantially from that found in high‐income countries. This suggests environmental factors occurring in low‐ and middle‐income countries might not have a direct association with the excess mortality in the depressed elderly.

With the fast population aging, functional disability among the elderly is becoming a major public health issue. Depression is highly prevalent in this phase of life and may be associated with a significant proportion of the disability among elderly populations. We investigated the association of depressive symptoms and ICD-10 depression with functional disability in older adults and estimated the corresponding population attributable fractions (PAF). A cross-sectional one-phase population-based study was carried out with 2,072 individuals aged 65 years or over living in a low-income area of São Paulo, Brazil. Depressive symptoms and ICD-10 depression were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We assessed functional disability with the WHO Disability Assessment Schedule Instrument. Prevalence Ratios and PAF were calculated using Poisson regression. The prevalence of depressive symptoms and ICD-10 depression was 21.4 and 4.8 %, respectively. Depression and depressive symptoms were strongly associated with high functional disability, even after adjustment for demographic factors, socioeconomic conditions, physical morbidities, and dementia. The PAFs for depressive symptoms and ICD-10 depression were 12.0 % for each of the psychiatric morbidity. Depressive symptoms contributed as much as ICD-10 depression to the population burden of functional disability in the elderly. Effective management of clinically significant depressive symptoms, delivered mainly at the primary care level, may reduce the total population disability.

INTRODUÇÃO: Com o rápido processo de envelhecimento populacional, a incapacidade funcional em idosos tem se tornado um importante problema de saúde pública globalmente. Depressão é uma morbidade bastante prevalente nessa fase da vida e pode estar associada com uma proporção significativa da incapacidade funcional na população de idosos. OBJETIVOS: Avaliar os níveis de incapacidade funcional, os principais fatores associados e o impacto dos transtornos mentais na incapacidade funcional de idosos vivendo na comunidade; examinar os fatores preditores de incapacidade funcional em um período de dois anos. MÉTODO: A presente investigação é parte da coorte prospectiva de base populacional "São Paulo Ageing & Health Study" (SPAH), que incluiu idosos com 65 anos ou mais, residentes de uma área economicamente menos favorecida na região Oeste da cidade de São Paulo. Os participantes foram identificados por arrolamento domiciliar e entrevistados em seus domicílios seguindo protocolo padronizado de pesquisa. A avaliação de incapacidade funcional foi realizada com o instrumento "World Health Organization Disability Assessment Schedule 2.0", criado para avaliar níveis de incapacidade conforme as definições e critérios da International Classification of Functioning, Disability and Health da Organização Mundial de Saúde, na sua versão com 12 itens. Depressão pelos critérios diagnósticos da CID-10 e sintomas depressivos foram avaliados com o instrumento Geriatric Mental State. Foram examinadas as associações independentes entre os transtornos mentais e incapacidade funcional através de modelos de regressão multivariada e modelos longitudinais multinível. Também foi calculada a Fração Atribuível na População dos transtornos mentais na incapacidade funcional dos idosos. RESULTADOS: Foram incluídos 2.072 idosos no período de 2003 a 2005. Mobilidade, atividades de vida diárias e participação na sociedade foram os domínios de incapacidade funcional mais afetados nessa população. A prevalência de depressão clinicamente significativa foi 26,2% (IC 95% 24,3-28,1), sendo 4,8% para depressão CID-10 e 21,4% para sintomas depressivos. Demência, depressão CID-10 e problema em membros apresentaram as associações de maior magnitude com as médias dos escores totais padronizados de incapacidade funcional, seguidos por sintomas depressivos, AVC e DPOC. Sintomas depressivos e depressão CID-10 foram responsáveis por 25,0% do total de incapacidade funcional grave nessa população. Dos idosos incluídos no SPAH, 1.661 foram reavaliados após dois anos. No seguimento, 56,1% dos idosos permaneceram com o mesmo nível de incapacidade funcional, 21,8% melhoraram e 22,1% pioraram. Os idosos que apresentaram sintomas depressivos, depressão CID-10 e demência na inclusão tiveram maior chance de piora da incapacidade funcional após dois anos, independentemente da categoria de incapacidade na inclusão do estudo e das morbidades físicas presentes. CONCLUSÃO: Os transtornos mentais em idosos, principalmente os sintomas depressivos e a depressão CID-10, apresentam asso...

Brazil has one of the fastest aging populations in the world and the incidence of cognitive impairment in the elderly is expected to increase exponentially. We examined the association between cognitive impairment and fruit and vegetable intake and associated factors in a low-income elderly population. A cross-sectional population-based study was carried out with 1849 individuals aged 65 or over living in São Paulo, Brazil. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Fruit and vegetable intake was assessed with a Food Frequency Questionnaire (FFQ) and categorized into quartiles of intake and into total daily fruit and vegetable intake using the cut-off points for the WHO recommendations (<400grams/day or ≥400 grams/day). The association between cognitive impairment and each quartile of intake, and WHO recommendation levels, was evaluated in two separate multivariate logistic models. The WHO recommendations for daily intakes ≥400 grams/day were significantly associated with 47% decreased prevalence of cognitive impairment. An effect modification was found in both models between cognitive impairment and “years of education and physical activity” and “years of education and blood levels of HDL” So that, having 1 or more years of education and being physically active or having 1 or more years of education and levels higher than 50 mg/dl of HDL-cholesterol strongly decreased the prevalence of cognitive impairment. In this socially deprived population with very low levels of education and physical activity and fruit and vegetable intake, those who attained WHO recommendations, had 1 year or more of education and were physically active had a significantly lower prevalence of cognitive impairment. A more comprehensive understanding of the social determinants of mental health is needed to develop effective public policies in developing countries.