Skip to main content Accessibility help
×
Home

Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people

  • J. Damián (a1) (a2), R. Pastor-Barriuso (a1) (a3), E. Valderrama-Gama (a4) and J. de Pedro-Cuesta (a1) (a2)

Abstract

Background.

Studies on depression and mortality in nursing homes have shown inconclusive findings, and none has studied the role of detection. We sought to measure the association of depression with long-term all-cause mortality in institutionalised older people and evaluate a potential modification in the association by its detection status.

Methods.

We selected a stratified cluster sample of 591 residents aged 75 years or older (mean age 84.5 years) living in residential and nursing homes of Madrid, Spain, who were free of severe cognitive impairment at the 1998–1999 baseline interview. Mortality was ascertained until age 105 years or September 2013 (median/maximum follow-up 4.8/15.2 years) through linkage to the Spanish National Death Index. Detected depression was defined at baseline as a physician's diagnosis or antidepressant use, undetected depression as significant depressive symptoms (score of 4 or higher on the ten-item version of the Geriatric Depression Scale) without documented diagnosis or treatment, and no depression as the absence of diagnosis, treatment, and symptoms. Constant and age-dependent hazard ratios for mortality comparing detected and undetected depression with no depression were estimated using Cox models, and absolute years of life gained and lost using Weibull models.

Results.

The baseline prevalences of detected and undetected depression were 25.9 and 18.8%, respectively. A total of 499 participants died during 3575 person-years of follow-up. In models adjusted for age, sex, type of facility, number of chronic conditions, and functional dependency, overall depression was not associated with long-term all-cause mortality (hazard ratio 0.87, 95% confidence interval (CI): 0.70–1.08). However, compared with no depression, detected depression showed lower mortality (hazard ratio 0.63, 95% CI: 0.46–0.86), while undetected depression registered higher, not statistically significant, mortality (hazard ratio 1.35, 95% CI: 0.98–1.86). The median life expectancy increased by 1.8 years (95% CI: −3.1 to 6.7 years) in residents with detected depression and decreased by 6.3 years (95% CI: 2.6–10.1 years) in those undetected. Results were more marked in women than men and they were robust to the exclusion of antidepressants from the definition of depression and also to the use of a stricter cut-off for the presence of depressive symptoms.

Conclusions.

The long-term mortality risk associated with depression in nursing homes depends on its detection status, with better prognosis in residents with detected depression and worse in those undetected. The absolute impact of undetected depressive symptoms in terms of life expectancy can be prominent.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: J. Damián, National Center for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, 28029 Madrid, Spain. (Email: jdamian@isciii.es)

References

Hide All
Alexopoulos, GS, Abrams, RC, Young, RC, Shamoian, CA (1988). Cornell scale for depression in Dementia. Biological Psychiatry 23, 271284.
Barca, ML, Engedal, K, Laks, J, Selbaek, G (2010). A 12 months follow-up study of depression among nursing-home patients in Norway. Journal of Affective Disorders 120, 141148.
Beekman, AT, Geerlings, SW, Deeg, DJ, Smit, JH, Schoevers, RS, de Beurs, E, Braam, AW, Penninx, BW, Van Tilburg, W (2002). The natural history of late-life depression: a 6-year prospective study in the community. Archives of General Psychiatry 59, 605611.
Bogner, HR, Morales, KH, Reynolds, CF III, Cary, MS, Bruce, ML (2012). Course of depression and mortality among older primary care patients. American Journal of Geriatric Psychiatry 20, 895903.
Boyle, VL, Roychoudhury, C, Beniak, R, Cohn, L, Bayer, A, Katz, I (2004). Recognition and management of depression in skilled-nursing and long-term care settings: evolving targets for quality improvement. American Journal of Geriatric Psychiatry 12, 288295.
Cohen-Mansfield, J, Marx, MS, Lipson, S, Werner, P (1999). Predictors of mortality in nursing home residents. Journal of Clinical Epidemiology 52, 273280.
Cox, C, Chu, H, Schneider, MF, Munoz, A (2007). Parametric survival analysis and taxonomy of hazard functions for the generalized gamma distribution. Statistics in Medicine 26, 43524374.
Cuijpers, P (2001). Mortality and depressive symptoms in inhabitants of residential homes. International Journal of Geriatric Psychiatry 16, 131138.
Cuijpers, P, Vogelzangs, N, Twisk, J, Kleiboer, A, Li, J, Penninx, BW (2013). Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both. British Journal of Psychiatry 202, 2227.
Cuijpers, P, Vogelzangs, N, Twisk, J, Kleiboer, A, Li, J, Penninx, BW (2014). Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. American Journal of Psychiatry 171, 453462.
Damián, J, Pastor-Barriuso, R, Valderrama-Gama, E (2010). Descriptive epidemiology of undetected depression in institutionalized older people. Journal of the American Directors Association 11, 312319.
D'Ath, P, Katona, P, Mullan, E, Evans, S, Katona, C (1994). Screening, detection and management of depression in elderly primary care attenders. I: the acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Family Practice 11, 260266.
Drageset, J, Eide, GE, Ranhoff, AH (2013). Anxiety and depression and mortality among cognitively intact nursing home residents with and without a cancer diagnosis: a 5-year follow-up study. Cancer Nursing 36, E68E74.
Fenton, J, Raskin, A, Gruber-Baldini, AL, Menon, AS, Zimmerman, S, Kaup, B, Loreck, D, Ruskin, PE, Magaziner, J (2004). Some predictors of psychiatric consultation in nursing home residents. American Journal of Geriatric Psychiatry 12, 297304.
Gruber-Baldini, AL, Zimmerman, SI, Mortimore, E, Magaziner, J (2000). The validity of the minimum data set in measuring the cognitive impairment of persons admitted to nursing homes. Journal of the American Geriatrics Society 48, 16011606.
Hartmaier, SL, Sloane, PD, Guess, HA, Koch, GG (1994). The MDS Cognition Scale: a valid instrument for identifying and staging nursing home residents with dementia using the Minimum Data Set. Journal of the American Geriatrics Society 42, 11731179.
Hess, KR (1994). Assessing time-by-covariate interactions in proportional hazards regression models using cubic spline functions. Statistics in Medicine 13, 10451062.
Hinton, L, Zweifach, M, Oishi, S, Tang, L, Unutzer, J (2006). Gender disparities in the treatment of late-life depression: qualitative and quantitative findings from the IMPACT trial. American Journal of Geriatric Psychiatry 14, 884892.
Hybels, CF, Pieper, CF, Blazer, DG (2002). Sex differences in the relationship between subthreshold depression and mortality in a community sample of older adults. American Journal of Geriatric Psychiatry 10, 283291.
Izal, M, Montorio, I (1993). Adaptation of the Geriatric Depression Scale in Spain: a preliminary study. Clinical Gerontologist 13, 8391.
Jongenelis, K, Pot, AM, Eisses, AM, Gerritsen, DL, Derksen, M, Beekman, AT, Kluiter, H, Ribbe, MW (2005). Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients. International Journal of Geriatric Psychiatry 20, 10671074.
Kane, KD, Yochim, BP, Lichtenberg, PA (2010). Depressive symptoms and cognitive impairment predict all-cause mortality in long-term care residents. Psychology and Aging 25, 446452.
Kiecolt-Glaser, JK, Glaser, R (2002). Depression and immune function: central pathways to morbidity and mortality. Journal of Psychosomatic Research 53, 873876.
Martínez de la Iglesia, J, Onís Vilches, MC, Dueñas-Herrero, R, Albert Colomer, C, Aguado Taberné, C, Luque Luque, R (2002). The Spanish version of the Yesavage abbreviated questionnaire (GDS) to screen depressive dysfunctions in patients older than 65 years. Medifam 12, 620630.
Ministerio de Sanidad Servicios Sociales e Igualdad (2014). Spanish National Death Index. Retrieved 29 June 2014. https://www.msssi.gob.es/en/estadEstudios/estadisticas/estadisticas/estMinisterio/IND_TipoDifusion.htm.
Murray, J, Banerjee, S, Byng, R, Tylee, A, Bhugra, D, Macdonald, A (2006). Primary care professionals’ perceptions of depression in older people: a qualitative study. Social Science and Medicine 63, 13631373.
O'Connor, BP, Vallerand, RJ (1998). Psychological adjustment variables as predictors of mortality among nursing home residents. Psychology and Aging 13, 368374.
Parmelee, PA, Katz, IR, Lawton, MP (1992). Depression and mortality among institutionalized aged. Journal of Gerontology 47, 310.
Pfeiffer, E (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society 23, 433441.
Rovner, BW, German, PS, Brant, LJ, Clark, R, Burton, L, Folstein, MF (1991). Depression and mortality in nursing homes. Journal of the American Medical Association 265, 993996.
Schulz, R, Drayer, RA, Rollman, BL (2002). Depression as a risk factor for non-suicide mortality in the elderly. Biological Psychiatry 52, 205225.
Shah, AK, Phongsathorn, V, Bielawska, C, Katona, C (1996). Screening for depression among geriatric inpatients with short versions of the Geriatric Depression Scale. International Journal of Geriatric Psychiatry 11, 915918.
Shah, S, Vanclay, F, Cooper, B (1989). Improving the sensitivity of the Barthel index for stroke rehabilitation. Journal of Clincal Epidemiology 42, 703709.
Sun, W, Schooling, CM, Chan, WM, Ho, KS, Lam, TH (2011). The association between depressive symptoms and mortality among Chinese elderly: a Hong Kong cohort study. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 66, 459466.
Sutcliffe, C, Burns, A, Challis, D, Mozley, CG, Cordingley, L, Bagley, H, Huxley, P (2007). Depressed mood, cognitive impairment, and survival in older people admitted to care homes in England. American Journal of Geriatric Psychiatry 15, 708715.
Thiebaut, AC, Benichou, J (2004). Choice of time-scale in Cox's model analysis of epidemiologic cohort data: a simulation study. Statistics in Medicine 23, 38033820.
White, J, Zaninotto, P, Walters, K, Kivimaki, M, Demakakos, P, Shankar, A, Kumari, M, Gallacher, J, Batty, GD (2015). Severity of depressive symptoms as a predictor of mortality: the English longitudinal study of ageing. Psychological Medicine 45, 27712779.
Wulsin, LR, Vaillant, GE, Wells, VE (1999). A systematic review of the mortality of depression. Psychosomatic Medicine 61, 617.

Keywords

Related content

Powered by UNSILO
Type Description Title
PDF
Supplementary materials

Damián supplementary material S1
Damián supplementary material

 PDF (189 KB)
189 KB

Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people

  • J. Damián (a1) (a2), R. Pastor-Barriuso (a1) (a3), E. Valderrama-Gama (a4) and J. de Pedro-Cuesta (a1) (a2)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.