International Psychogeriatrics

Research Article

Role of severity and gender in the association between late-life depression and all-cause mortality

Hyun-Ghang Jeonga1, Jung Jae Leea2, Seok Bum Leea3, Joon Hyuk Parka4, Yoonseok Huha5, Ji Won Hana5, Tae Hui Kima5, Ho Jun China6 and Ki Woong Kima6a7 c1

a1 Department of Psychiatry, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea

a2 Department of Psychiatry, Kyungbook National University Hospital, Daegu, Korea

a3 Department of Psychiatry, Dankook University Hospital, Chungcheongnamdo, Korea

a4 Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea

a5 Department of Neuropsychiatry, Seoul National University Bundang Hospital. Seongnam, Korea

a6 Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggido, Korea

a7 Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea

ABSTRACT

Background: Mortality associated with depression may be influenced by severity of depression and gender. We investigated the differential impacts on all-cause mortality of late-life depression by the type of depression (major depressive disorder, MDD; minor depressive disorder, MnDD; subsyndromal depression, SSD) and gender after adjusting comorbid conditions in the randomly sampled elderly.

Methods: One thousand community-dwelling elderly individuals were enrolled. Standardized face-to-face clinical interviews, neurological examination, and physical examination were conducted to diagnose depressive disorders and comorbid cognitive disorders. Depressive disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria and SSD to study-specific operational criteria. Five-year survivals were compared between groups using Cox proportional hazards models.

Results: By the end of 2010, 174 subjects (17.4%) died. Depressive disorder (p = 0.001) and its interaction term with gender (p < 0.001) were significant in predicting five-year survival. MDD was an independent risk factor for mortality in men (hazard ratio = 3.65, 95% confidence interval = 1.67–7.96) whereas MnDD and SSD were not when other risk factors were adjusted.

Conclusions: MDD may directly confer the risk of mortality in elderly men whereas non-major depression may be just an indicator of increased mortality in both genders.

(Received September 11 2012)

(Reviewed October 14 2012)

(Revised November 06 2012)

(Accepted November 10 2012)

(Online publication December 21 2012)

Key words:

  • late-life depression;
  • major depressive disorder;
  • minor depressive disorder;
  • subsyndromal depression;
  • mortality;
  • gender

Correspondence:

c1 Correspondence should be addressed to: Ki Woong Kim, Department of Neuropsychiatry, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea. Phone: +82-31-7877439; Fax: +82-31-7874058. Email: kwkimmd@snu.ac.kr.