Association between depressive symptoms and mortality in older women. Study of Osteoporotic Fractures Research Group.
ABSTRACT Major depression is associated with increased mortality, but it is not known whether patients who report depressive symptoms have greater mortality.
We performed a prospective cohort study of 7518 white women 67 years of age or older who were recruited from population-based listings in Baltimore, Md, Minneapolis, Minn, Portland, Ore, and the Monongahela Valley, Pa. Participants completed the Geriatric Depression Scale (short form) and were considered depressed if they reported 6 or more of 15 possible symptoms of depression. Women were followed up for an average of 6 years. If a participant died, we obtained a copy of the official death certificate and hospital records, if available, and used International Classification of Diseases, Ninth Revision, codes to classify death attributable to cardiovascular, cancer, or noncancer, noncardiovascular cause.
Mortality during 7-year follow-up varied from 7% in women with no depressive symptoms to 17% in those with 3 to 5 symptoms to 24% in those with 6 or more symptoms of depression (P<.001). Of 473 women (6.3%) with 6 or more depressive symptoms at baseline, 24% died (111 deaths in 2610 woman-years of follow-up) compared with 11% of women who reported 5 or fewer symptoms of depression (760 deaths in 41 460 woman-years of follow-up) (P<.001). Women with 6 or more depressive symptoms had a 2-fold increased risk of death (age-adjusted hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.75-2.61; P<.001) compared with those who had 5 or fewer depressive symptoms. This association remained strong after adjusting for potential confounding variables, including history of myocardial infarction, stroke, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, smoking, perceived health, and cognitive function (HR, 1.47; 95% CI, 1.14-1.88; P=.003). Depressive symptoms were associated with an increased adjusted risk of death from cardiovascular diseases (HR, 1.8; 95% CI, 1.2-2.5; P= .003), and non-cancer, noncardiovascular diseases (HR, 1.8; 95% CI, 1.2-2.7; P = .01), but were not associated with deaths from cancer (HR, 1.0; 95% CI, 0.6-1.7; P=.93).
Depressive symptoms are a significant risk factor for cardiovascular and noncancer, noncardiovascular mortality but not cancer mortality in older women. Whether depressive symptoms are a marker for, or a cause of, life-threatening conditions remains to be determined.
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ABSTRACT: Objective: To investigate the longitudinal relationship between subjective and objective sleep disturbance and depressive symptoms. Design: Longitudinal. Setting: Three US clinical centers. Participants: Nine hundred fifty-two community-dwelling older women (70 y or older). Measurements: At baseline, subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measures were assessed with wrist actigraphy. Depressive symptoms were assessed with the Geriatric Depression Scale (GDS) at baseline and approximately 5 y later. The analysis was restricted to women with few (GDS 0-2) depressive symptoms at baseline. Results: There was an independent association between greater PSQI score (per standard deviation increase, indicating worse subjective sleep quality) at baseline and greater odds of worsening depressive symptoms (>= 2-point increase in GDS) (Multivariate Odds Ratio [MOR] 1.19, confidence interval [CI] 1.01-1.40, P = 0.036). Higher scores specifically on the sleep quality (MOR 1.41, CI 1.13-1.77, P < 0.003) and sleep latency (MOR 1.21, CI 1.03-1.41, P = 0.018) PSQI subscales were also associated with greater odds for worsening depressive symptoms. Objective assessments revealed an association between baseline prolonged wake after sleep onset (WASO >= 60 min) and worsening depressive symptoms at follow-up (MOR 1.36, CI 1.01-1.84, P = 0.046). There were no associations between other objectively assessed sleep measures and worsening depressive symptoms. Conclusions: In older women with few or no depressive symptoms at baseline, those with more subjectively reported sleep disturbance and more objectively assessed fragmentation of sleep at baseline had greater odds of worsening depressive symptoms 5 y later. Future studies investigating this relationship in more detail are indicated.Sleep 07/2014; 37(7):1179-87. DOI:10.5665/sleep.3834 · 5.06 Impact Factor
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ABSTRACT: Withdrawal from dialysis is an appropriate decision for situations in which the burdens of treatment outweigh the benefits. Alternately, it can be viewed as a public health problem and suicide equivalent that contributes to the high mortality of end-stage renal disease (ESRD). More than one in five deaths of patients with ESRD are preceded by dialysis cessation, and approximately 15,000 Americans died last year following a determination to stop this life-support treatment. This article discusses what is known about the psychosocial aspects of the patients who terminate dialysis, the role of depression and other psychiatric disorders, the family perspective, and the relationship of these decisions to suicide.Seminars in Dialysis 03/2005; 18(2). DOI:10.1111/j.1525-139X.2005.18201.x · 2.25 Impact Factor
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ABSTRACT: ABSTRACT Background: Depression in the elderly is often associated with coexisting medical illnesses. We investigated the individual and combined impacts of depression and medical illnesses on disability and quality of life among community-living older persons. Methods: Cross-sectional and longitudinal analyses of data from 1,844 participants aged 55 and above of the Singapore Longitudinal Aging Study (SLAS-1). Baseline depressive symptoms (Geriatric Depressive Scale, GDS≥5) and chronic medical comorbidity (≥2) from self-reports were related to baseline and 2-year follow up instrumental and basic activities of daily living (IADL-BADL), and quality of life (Medical Outcomes Study 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) scores. Results: The prevalence of depressive symptoms was 11.4%. In main effect analyses of cross-sectional and longitudinal relationships, depression and medical comorbidity were individually associated with higher risk of IADL-BADL disability and lower PCS and MCS scores of quality of life, and only medical comorbidity was associated with increased risk of hospitalization. Significant interactive effects of depression and medical comorbidity were observed in longitudinal relationships with IADL-BADL disability (p = 0.03), PCS (p < 0.01), and MCS (p < 0.01) scores at follow up. The associations of medical comorbidity with increased odds of IADL-BADL disability and decreased SF-12 PCS and MCS scores were at least threefolds stronger among depressed than nondepressed individuals. Conclusion: Medical comorbidities and depression exert additive and multiplicative effects on functional disability and quality of life. The adverse impact and potential treatment benefits of coexisting mental and physical conditions should be seriously considered in clinical practice.International Psychogeriatrics 04/2014; DOI:10.1017/S1041610214000611 · 1.89 Impact Factor