Depression Predicts Mortality in the Young Old, but Not in the Oldest Old: Results From the Berlin Aging Study

doi:10.1097/JGP.0b013e31818254eb

The American Journal of Geriatric Psychiatry

Volume 16, Issue 10, October 2008, Pages 844-852

https://doi.org/10.1097/JGP.0b013e31818254eb Get rights and content

Objective

There is evidence that depression in old age is associated with an increased mortality risk, but studies have also yielded inconclusive results. Possible moderators of the depression-mortality association in old age discussed in the literature are differences in cardiovascular morbidity, effects of multimorbidity, and increasing effects of subthreshold depression symptoms, such as minor depression and loneliness, on mortality. This study is concerned with the depression-mortality association in old and very old age.

Method

Information about mortality status and dates of death for 497 participants of the Berlin, Germany, Aging Study (mean age: 85.16 years; range: 70–103 years), a population based, age-stratified, longitudinal study, were obtained from the Berlin, Germany, City Registry for up to 15 years. The authors calculated proportional hazard regression models to examine associations between clinical diagnosis of depression at baseline assessment and subsequent mortality for young-old (70–84 years; N = 243; 68% deceased) and oldest-old participants (85+ years; N = 254; 98% deceased). In an additional step, the authors examined whether depression-mortality associations remained after statistically controlling for the effects of other mortality predictors including age, gender, education, dementia, cardiovascular risk factors, and other somatic diseases.

Results

Our analyses revealed strong predictive effects of depression diagnoses for mortality among the young old (Relative Risk = 1.60, 95% Confidence Interval = 1.13–2.26) that were not due to the effects of other mortality predictors (Relative Risk = 1.56, 95% Confidence Interval = 1.09–2.22). Among the oldest old, no depression-mortality associations were found.

Conclusion

Depression is a significant risk factor for all-cause mortality in old age, yet the risk conveyed by depression does not hold in very old age. Possible underlying mechanisms in the very old are discussed.

Section snippets

Participants and Procedure

We used data from the interdisciplinary Berlin Aging Study (BASE).²⁴ The cross-sectional BASE sample at T1 (N = 516; M = 84.92 years, SD: 8.66, range: 70–103) was stratified by age and gender with 43 men and 43 women in each of six different age brackets (70–74, 75–79, 80–84, 85–89, 90–94, and 95+ years; born between 1887 and 1922). To obtain this sample, a total of 1,908 individuals, randomly drawn from the Berlin, Germany, City Registry, were approached for participation. Of those, 516

RESULTS

Demographic characteristics of the sample are shown in Table 1. Of the 243 young-old participants, 56 (23%) were diagnosed with depression, whereas among the oldest old, 72 (28%) were diagnosed with depression (p >0.10). Both depression diagnosis and being older than age 85 were associated with a larger number of deaths, χ² (1, N = 496) = 8.14, p = 0.004 and χ² (1, N = 496) = 81.05, p = 0.000, respectively.

Overall, depressed participants were more often female than nondepressed participants, χ²

DISCUSSION

Consistent with the majority of studies in the literature,6, 7, 8, 9, 10 we found an increased mortality risk for clinically diagnosed depression in older adults aged 70–84 years, which held beyond the effects of age, gender, and the presence of dementia, cardiovascular, and other somatic diseases. The risk was sizable and amounted to a 3-year mortality difference, on average, between older adults who suffered from depression and those who did not. At the same time, we did not find this effect

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: This study was conducted in the context of the Berlin, Germany, Aging Study (BASE), which was financially supported by two German Federal Departments: the Department of Research and Technology (13 TA 011: 1988–1991) and the Department of Family and Senior Citizens (1991–1998). Since 1999, BASE has been funded by the Max Planck Institute for Human Development, Berlin, Germany, where the study is located. Members of the Steering Committee are P. B. Baltes and J. Smith (psychology), K. U. Mayer (sociology), E. Steinhagen-Thiessen and M. Borchelt (internal medicine and geriatrics), and H. Helmchen and F. Reischies (psychiatry). Field research was coordinated at various phases by R. Nuthmann, M. Neher, and K. Fröhlich. Michael A. Rapp and Denis Gerstorf are Junior Fellows in the Max Planck International Research Network on Aging MaxnetAging. Parts of this article were prepared while Denis Gerstorf was at the Department of Psychology, University of Virginia on a research fellowship awarded by the German Research Foundation (DFG).

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Regular Research ArticlesDepression Predicts Mortality in the Young Old, but Not in the Oldest Old: Results From the Berlin Aging Study

Objective

Method

Results

Conclusion

Section snippets

Participants and Procedure

RESULTS

DISCUSSION

J Affect Disord

Biol Psychiatry

Am J Geriatr Psychiatry

J Chronic Dis

Trends Immunol

Mech Ageing Dev

Depression in late life: review and commentary

J Gerontol A Biol Sci Med Sci

Relapse after recovery from unipolar depression: a critical review

Psychol Bull

The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder

J Affect Disord

Psychiatric illnesses in old age

A systematic review of the mortality of depression

Psychosom Med

Minor and major depression and the risk of death in older persons

Arch Gen Psychiatry

Association of depression and gender with mortality in old age. Results from the Amsterdam Study of the Elderly (AMSTEL)

Br J Psychiatry

Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression

Arch Gen Psychiatry

Depressive symptoms, coronary heart disease, and overall mortality in the Framingham Heart Study

Psychosom Med

Relationship of depression to death or hospitalization in patients with heart failure

Arch Intern Med

Depression and cardiac mortality: results from a community-based longitudinal study

Arch Gen Psychiatry

An examination of the linkage between ischemic heart disease and depression

Demography. Broken limits to life expectancy

Science

Predictors of mortality in the old-old in Israel: the Cross-sectional and Longitudinal Aging Study

J Am Geriatr Soc

Understanding changing risk factor associations with increasing age in adults

Ann Rev Public Health

Is depression in old age fatal only when people feel lonely?

Am J Psychiatry

Regular Research Articles
Depression Predicts Mortality in the Young Old, but Not in the Oldest Old: Results From the Berlin Aging Study