Six-year survival of depressed elderly Finns: a community study

Pulska, Tuula; Pahkala, Kimmo; Laippala, Pekka; Kivelä, Sirkka‐Liisa

doi:10.1002/(sici)1099-1166(199709)12:9<942::aid-gps668>3.0.co;2-z

Cited by 22 publications

(8 citation statements)

References 17 publications

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“…The results of previous studies investigating the mortality of older people with depression lend further support to our conclusions and are summarised in Table S1 (citations 50 to 62 [50]–[62] refer to studies listed in this table. Please see also review by Cuijpers et al [37]).…”

Section: Discussionsupporting

confidence: 83%

Depression, Antidepressant Use and Mortality in Later Life: The Health in Men Study

et al. 2010

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ContextDepression 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.ObjectiveTo 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.MethodsCohort study of 5,276 community-dwelling men aged 68–88 years living in Perth, Australia. We 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. We used the Western Australian Data Linkage System to monitor mortality.ResultsThere were 883 deaths between the study assessment and the 30th June 2008 (mean follow-up of participants: 6.0±1.1 years). The adjusted mortality hazard (MH) of men with clinically significant depression was 1.98 (95%CI = 1.61–2.43), and increased with the severity of symptoms: 1.39 (95%CI = 1.13–1.71) for questionable, 2.71 (95%CI = 2.13–3.46) for mild/moderate, and 3.32 (95%CI: 2.31–4.78) for severe depression. The use of antidepressants increased MH (HR = 1.31, 95%CI = 1.02–1.68). Compared with men who were not depressed and were not taking antidepressants, MH increased from 1.22 (95%CI = 0.91–1.63) for men with no depression who were using antidepressants to 1.85 (95%CI = 1.47–2.32) for participants who were depressed but were not using antidepressants, and 2.97 (95%CI = 1.94–4.54) 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 the Charlson comorbidity index.ConclusionsThe 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.

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Section: Discussionsupporting

confidence: 83%

Depression, Antidepressant Use and Mortality in Later Life: The Health in Men Study

et al. 2010

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“…This study is based on the Ähtäri longitudinal epidemiological research project concerning depression in elderly people 1 – 3. The initial series consisted of people born in 1923or earlier and living in the municipality of Ähtäri, Finland, on 1January 1984(n=1529).…”

Section: Subjects Methods and Resultsmentioning

confidence: 99%

“…The follow up study was performed in 1989-90with a participation rate of 94%. Depression was determined after semistructured interviews by the criteria of the Diagnostic and Statistical Manual of Mental Disorders , third edition (DSM-III) 1 – 3…”

Section: Subjects Methods and Resultsmentioning

confidence: 99%

Follow up study of longstanding depression as predictor of mortality in elderly people living in the community

Pulska

Pahkala²,

Laippala

et al. 1999

BMJ

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Longstanding and recurrent depressive disorders are quite common in elderly people.1 2 Not much is known, however, of their clinical course and prognosis, including mortality. The need for treatment of longstanding, less severe depressive disorders is a matter of discussion.We studied the relation between longstanding or recurrent depressive disorders and mortality and that between recovery from depressive disorders and mortality in elderly people. Subjects, methods, and resultsThis study is based on the Ähtäri longitudinal epidemiological research project concerning depression in elderly people.1-3 The initial series consisted of people born in 1923 or earlier and living in the municipality of Ähtäri, Finland, on 1 January 1984 (n = 1529). In the first study in 1984-5 the participation rate was 91%. The follow up study was performed in 1989-90 with a participation rate of 94%. Depression was determined after semistructured interviews by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III). 1-3We examined mortality in subjects with a longstanding or recurrent course of depression and those who had recovered. Three groups were formed from those people without dementia who were alive in both 1984-5 and 1989-90: people depressed in both assessments (n = 78), people depressed in 1984-5 but not depressed in 1989-90 (n = 101), and people not depressed in both assessments (n = 634). The mean (SD) age of those participating in the follow up study was 74.3 (6.1) years on 1 January 1989. The mortality data from the official statistics were collected for a period from the individual examination days in 1989-90 to 31 December 1995.The causes of death did not differ between the groups, cardiovascular and cerebrovascular diseases and malignant neoplasms being the most common. According to Kaplan-Meier survival analysis, 48% of the people with depression at both time points had died compared with 26% in the group without depression at both times (P < 0.001). In the group with depression in 1984-5 but not in 1989-90, 31% had died, so the survival in this group did not differ from that in the group without depression at either time (P = 0.286). The role of depression as a predictor of mortality was analysed with Cox's proportional hazards model, with age, sex, smoking, physical health, and functional abilities taken into account. Longstanding depression predicted mortality even when these factors were controlled for, while recovery from depression did not (table). CommentLongstanding depression seems to be a predictor for mortality in elderly people. In this study the groups of depressed people were formed on the basis of two measurements at interval of 5 years, and there were no data on the course of depression between the measurements. We assumed, however, that subjects with depression at both time points were suffering from longstanding or recurrent depression, and that this group and the group with depression at the first time point but without depression at the second differed f...

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“…Sampson et al (2009) revealed that cognitive impairment and lack of social support are independent mortality risk factors for older depressed persons, while Greenlee et al (2010) demonstrated how anxiety impairs remission of depression during treatment of older persons. Pulska et al (1997) found that a previous diagnosis of depression is not predictive of increased mortality in elderly persons (>60) when other factors known to influence survival are taken into account.…”

Section: Introductionmentioning

confidence: 88%

Surviving depressive ill‐health: A qualitative systematic review of older persons' narratives

Holm

Severinsson

2013

Nursing & Health Sciences

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Six-year survival of depressed elderly Finns: a community study

Cited by 22 publications

References 17 publications

Depression, Antidepressant Use and Mortality in Later Life: The Health in Men Study

Depression, Antidepressant Use and Mortality in Later Life: The Health in Men Study

Follow up study of longstanding depression as predictor of mortality in elderly people living in the community

Surviving depressive ill‐health: A qualitative systematic review of older persons' narratives

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