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Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

Published online by Cambridge University Press:  11 April 2012

E. Scafato ,
L. Galluzzo ,
S. Ghirini ,
C. Gandin ,
A. Rossi ,
V. Solfrizzi ,
F. Panza ,
A. Di Carlo ,
S. Maggi  and
G. Farchi
E. Scafato
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
L. Galluzzo*
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
S. Ghirini
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
C. Gandin
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
A. Rossi
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
V. Solfrizzi
Affiliation:
Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Italy
F. Panza
Affiliation:
Geriatric Unit and Gerontology–Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
A. Di Carlo
Affiliation:
Department of Neurological Sciences, University of Florence and Institute of Neuroscience, National Research Council of Italy (CNR), Firenze, Italy
S. Maggi
Affiliation:
Institute of Neuroscience, National Research Council of Italy (CNR), Padova, Italy
G. Farchi
Affiliation:
Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
*
*Address for correspondence: Dr L. Galluzzo, Reparto Salute Popolazione e suoi Determinanti, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore di Sanità (ISS), Via Giano della Bella 34, 00161 Rome, Italy. (Email: lucia.galluzzo@iss.it)
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Abstract

Background

Depression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.

Method

As part of a prospective, population-based study on a random sample of 5632 subjects aged 65–84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.

Results

Severity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15–1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32–0.95; men MHR 0.59, 95% CI 0.37–0.93). Neither sociodemographic nor medical confounders significantly modified these associations.

Conclusions

Consistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

Keywords

Depressionelderlyepidemiologymortality
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 12 , December 2012 , pp. 2619 - 2629
Copyright
Copyright © Cambridge University Press 2012

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