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Survival Rate and Causes of Mortality in the Elderly with Depression
  1. Tsuyoshi Kawamura,
  2. Toshiki Shioiri,
  3. Kuniaki Takahashi,
  4. Vural Ozdemir,
  5. Toshiyuki Someya
  1. From the Department of Psychiatry (T.K., T. Shioiri, K.T., T. Someya), Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Biomarker and Clinical Pharmacology Unit (V.O.), VA Long Beach Medical Center, School of Medicine, University of California, Irvine, Irvine, CA.
  1. Supported by intramural research funds from Niigata University (to T. Someya).
  2. Address correspondence to: Dr. Toshiyuki Someya, Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, 757 Asahimachidori-ichibancho, Niigata 951-8510, Japan; e-mail: someya{at}med.niigata-u.ac.jp.

A 15-Year Prospective Study of a Japanese Community Sample, the Matsunoyama-Niigata Suicide Prevention Project

Abstract

Objective To compare long-term survival rates and causes of death in community-dwelling elderly with and without depression using the International Research Diagnostic Criteria administered by a psychiatrist.

Method From 1985 to 2000, we prospectively examined Japanese persons (N = 920) aged 65 years or older. Cases with depression (n = 158) and a control sample without depression (N = 762) were evaluated. The main outcome variables were survival rates and causes of mortality.

Results By 2000, 61% of the subjects with depression had died. By contrast, 48% had died in the control group at the completion of the 15-year follow-up. Using age-adjusted Kaplan-Meier survival analysis, we found a hazard ratio (HR) of 1.49 (95% confidence interval [CI] 1.16-1.89) for mortality in the depressed group compared with controls (p = .0009). Importantly, in female subjects with depression, the HR was 1.55 (95% CI 1.16-2.07; p = .002). In males with depression, by contrast, the HR (1.34) was not significant (95% CI 0.84-2.13; p = .19). Significantly more subjects died of cerebrovascular disorders, malignant tumors, respiratory disorders, or suicide after the onset of depression compared with controls (p < .05).

Conclusions Depression appears to be associated with a significant increase in the risk of mortality among elderly Japanese subjects, particularly in females. The elderly with a diagnosis of depression may be at an elevated risk of mortality owing to cerebrovascular disorder, malignant tumors, respiratory disorders, or suicide. These prospective data provide a new quantitative insight on gender differences and the long-term public health significance of depression among the community-dwelling elderly.

Key words
  • depression
  • mortality
  • gender-specific survival rate
  • prospective clinical investigation
  • cerebrovascular disease
  • Japanese
  • elderly

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