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Mortality, symptoms, and functional impairment in late-life depression

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Abstract

OBJECTIVE: To determine whether depressive symptoms measured at baseline are associated with mortality and to describe the course of depressive symptoms and their relation to physical decline in patients over a 6-year period.

DESIGN: Prospective cohort study conducted from 1990 through 1996.

SETTING: Urban academic primary care group practice.

PATIENTS: A cohort of 3,767 patients aged 60 years and older screened for depressive symptoms during routine office visits using the Centers for Epidemiologic Studies Depression Scale (CES-D) participated in the mortality study. A subsample of 300 patients with CES-D scores 16 or above and a subsample of 100 patients with CES-D scores less than 16 participated in the study of the course of depressive symptoms and physical decline.

MEASUREMENTS AND MAIN RESULTS: Mortality by December 1995 was measured for all screened patients; reinterviewed patients completed the CES-D and the Sickness Impact Profile (SIP). The mean follow-up period was 45 months (± SD 12.2 months); 561 (14.9%) of the patients died by December 1995. In proportional hazards models, age, gender, race, history of smoking, serum albumin value, and an ideal body weight in the lowest 10% were significant correlates of time to death, but the baseline CES-D was not. Patients with depressive symptoms had significantly worse physical and psychosocial functioning scores on the SIP than did patients without depressive symptoms. Using the generalized estimating equation method, the strongest predictor of the current CES-D score was the patient’s prior CES-D score. However, worsening physical functioning score on the SIP was also independently correlated with worse CES-D scores (p ≤ .001).

CONCLUSIONS: Symptoms of depression were not associated with mortality in this cohort of older adults. However, patients with depressive symptoms reported greater functional impairment than did those without depressive symptoms. Moreover, decline in physical functioning was independently correlated with a concurrent increase in depressive symptoms.

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References

  1. Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients. JAMA. 1989;262(7):914–9.

    Article  PubMed  CAS  Google Scholar 

  2. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days and days lost from work in a prospective epidemiologic survey. JAMA. 1990;264(19):2524–8.

    Article  PubMed  CAS  Google Scholar 

  3. Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA. 1992;267:1478–83.

    Article  PubMed  CAS  Google Scholar 

  4. Ormel J, Von Korff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. J Am Med Assoc. 1994;272:1741–8.

    Article  CAS  Google Scholar 

  5. Spitzer RL, Kroenke K, Linzer M, et al. Health-related quality of life in primary care patients with mental disorders. JAMA. 1995;274:1511–7.

    Article  PubMed  CAS  Google Scholar 

  6. Hirshfield RMA, Keller MB, Panico S, et al. The National Depressive and Manic-Depressive Association Consensus Statement on the Undertreatment of Depression. JAMA. 1997;277:333–40.

    Article  Google Scholar 

  7. Bruce ML, Seeman TE, Merrill SS, Blazer DG. The impact of depressive symptomatology on physical disability. Am J Public Health. 1994;84:1796–9.

    PubMed  CAS  Google Scholar 

  8. Rapp SR, Parisi SA, Wallace CE. Comorbid psychiatric disorders in elderly medical patients: a 1-year prospective study. Am Geriatr Soc. 1991;39:124–31.

    CAS  Google Scholar 

  9. Berkman LF, Berkman CS, Kasl S, et al. Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol. 1986;124:372–88.

    PubMed  CAS  Google Scholar 

  10. Kukull WA, Koepsell TD, Inui TS, et al. Depression and physical illness among elderly general medical clinic patients. J Affect Disord. 1986;10:153–62.

    Article  PubMed  CAS  Google Scholar 

  11. Katz IR. On the inseperability of mental and physical health in aged persons. Lessons from depression and medical comorbidity. Am J Geriatr Psychiatry. 1996;4:1–6.

    Google Scholar 

  12. Callahan CM, Wolinsky FD. Hospitalization for major depression among older Americans. J Gerontol. 1995;50A:M196–202.

    Google Scholar 

  13. Callahan CM, Hui SL, Nienaber NA, Musick BS, Tierney WM. Longitudinal study of depression and health services use among elderly primary care patients. J Am Geriatr Soc. 1994;42:833–8.

    PubMed  CAS  Google Scholar 

  14. Borson S, Barnes RA, Kukull WA, et al. Symptomatic depression in elderly medical outpatients. Prevalence, demography, and health utilization. J Am Geriatr Soc. 1986;34:341–47.

    PubMed  CAS  Google Scholar 

  15. Farmer ME, Locke BZ, Moscicki EK, Dannenberg AL, Larson DB, Radloff LS. Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up Study. Am J Epidemiol. 1988;128:1340–51.

    PubMed  CAS  Google Scholar 

  16. Katon W, Berg A, Robins AJ, et al. Depression: medical utilization and somatization. Western J Med. 1986;144:564–68.

    CAS  Google Scholar 

  17. Manning WG, Wells KB. The effects of psychological distress and psychological well-being on use of medical services. Med Care. 1992;30:541–53.

    Article  PubMed  Google Scholar 

  18. Thomas C, Kelman HR, Kennedy GJ, Ahn C, Yang C. Depressive symptoms and mortality in elderly persons. Gerontol Soc Sci. 1992;47(2):S80–7.

    CAS  Google Scholar 

  19. Callahan CM, Hendrie HC, Dittus RS, Brater DC, Hui SL, Tierney WM. Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc. 1994;42:839–46.

    PubMed  CAS  Google Scholar 

  20. Rovner BW, German PS, Brant LJ, Clark R, Burton L, Folstein MF. Depression and mortality in nursing homes. JAMA. 1991;265(8):993–6.

    Article  PubMed  CAS  Google Scholar 

  21. Ruberman W. Psychosocial influences on mortality of patients with coronary heart disease. JAMA. 1992;267(4):559–60.

    Article  PubMed  CAS  Google Scholar 

  22. Lyketsos CG, Hoover DR, Guccione M, et al. Depressive symptoms as predictors of medical outcomes in HIV infection. JAMA. 1993;270(21):2563–7.

    Article  PubMed  CAS  Google Scholar 

  23. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. The effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 1989;2:888–91.

    Article  PubMed  CAS  Google Scholar 

  24. Callahan CM, Kesterson JG, Tierney WM. The association of symptoms of depression with diagnostic testing among older adults. Ann Intern Med. 1997;126:426–32.

    PubMed  CAS  Google Scholar 

  25. Aneshensel CS, Frerichs RR, Huba GJ. Depression and physical illness: a multiwave, nonrecursive causal model. J Health Soc Behav. 1984;25:350–71.

    Article  PubMed  CAS  Google Scholar 

  26. Tierney WM, Miller ME, Hui SL, McDonald CJ. Practice randomization and clinical research. The Indiana experience. Med Care. 1991;29:JS57–64.

    PubMed  CAS  Google Scholar 

  27. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  28. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23:433–41.

    PubMed  CAS  Google Scholar 

  29. Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131:1121–3.

    PubMed  CAS  Google Scholar 

  30. Callahan CM, Hendrie HC, Tierney WM. Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med. 1995;122:422–9.

    PubMed  CAS  Google Scholar 

  31. Callahan CM, Tierney WM. Health services use and mortality among older primary care patients with alcoholism. J Am Geriatr Soc. 1995;43:1378–83.

    PubMed  CAS  Google Scholar 

  32. McDonald CM, Tierney WM, Martin DK, Overhage JM. The Regenstrief Medical Record System: 20 years experience in hospital outpatient clinics and neighborhood health centers. MD Comput. 1992;9:206–17.

    PubMed  CAS  Google Scholar 

  33. Mulrow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122:913–21.

    PubMed  CAS  Google Scholar 

  34. Hamilton M. A rating scale for depression. J Neurol Neursurg Psychiatry. 1960;23:56–62.

    CAS  Google Scholar 

  35. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981;19(8):787–805.

    Article  PubMed  CAS  Google Scholar 

  36. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–30.

    Article  PubMed  CAS  Google Scholar 

  37. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometreka. 1986;73:13–27.

    Article  Google Scholar 

  38. Karim MR, Zeger SL. GEE: A SAS Macro for Longitudinal Data Analysis. Baltimore, Md: Department of Biostatistics, The Johns Hopkins University. Technical report 674.

  39. Gallo JJ, Rabins PV, Lyketsos CG, Tien AY, Anthony JC. Depression without sadness: functional outcomes of nondysphoric depression in later life. J Am Geriatr Soc. 1997;45:570–8.

    PubMed  CAS  Google Scholar 

  40. Bruce ML, Leaf PJ, Rosal GPM, et al. Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area study. Am J Psychiatry. 1994;151:716–21.

    PubMed  CAS  Google Scholar 

  41. Corti MC, Guralnik JM, Salive ME, Sorkin JD. Serum albumin level and physical disability as predictors of mortality in older persons. JAMA. 1994;272:1036–42.

    Article  PubMed  CAS  Google Scholar 

  42. Guralnik JM, LaCroix AZ, Branch LG, Kasl SV, Wallace RB. Morbidity and disability in older persons in the years prior to death. Am J Public Health. 1991;81(4):443–7.

    Article  PubMed  CAS  Google Scholar 

  43. Reuben DB, Rubenstein LV, Hirsch SH, Hays RD. The value of functional status as a predictor of mortality: results of a prospective study. Am J Med. 1992;93:663–9.

    Article  PubMed  CAS  Google Scholar 

  44. Waxman HM, McCreary G, Weinrit RM, Carner EA. A comparison of somatic complaints among depressed and non-depressed older persons. Gerontologist. 1985;25:501–7.

    PubMed  CAS  Google Scholar 

  45. Phifer JF, Murrell SA. Etiologic factors in the onset of depressive symptoms in older adults. J Abnorm Psychol. 1986;95:282–91.

    Article  PubMed  CAS  Google Scholar 

  46. Kennedy GJ, Kelman HR, Thomas C. The emergence of depressive symptoms in late life: the importance of declining health and increasing disability. J Community Health. 1990;2:93–103.

    Article  Google Scholar 

  47. Hankin JR, Locke BZ. The persistence of depressive symptomatology among prepaid group practice enrollees: an exploratory study. Am J Public Health. 1982;72:1000–7.

    PubMed  CAS  Google Scholar 

  48. Lin N, Ensel WM. Depression-mobility and its social etiology: the role of life events and social support. J Health Soc Behav. 1984;25:176–88.

    Article  PubMed  CAS  Google Scholar 

  49. Sargeant K, Bruce ML, Florio LP, Weismann MM. Factors associated with 1-year outcome of major depression in the community. Arch Gen Psychiatry. 1990;47:519–26.

    PubMed  CAS  Google Scholar 

  50. Kennedy GJ, Kelman HR, Thomas C. Persistence and remission of depressive symptoms in late life. Am J Psychiatry. 1991;148:174–8.

    PubMed  CAS  Google Scholar 

  51. Wells KB, Burnam MA, Rogers W, Hays R, Camp P. The course of depression in adult outpatients. Arch Gen Psychiatry. 1992;49:788–94.

    PubMed  CAS  Google Scholar 

  52. Turner JR, Beiser M. Major depression and depressive symptomatology among the physically disabled. J Nerv Ment Dis. 1990;178:343–50.

    Article  PubMed  CAS  Google Scholar 

  53. McWhinney IR, Epstein RM, Freeman TR. Rethinking somatization. Ann Intern Med. 1997;126:747–50.

    PubMed  CAS  Google Scholar 

  54. Callahan CM, Hendrie HC, Tierney WM. The recognition and treatment of late life depression: a view from primary care. Int J Psychiatry Med. 1996;26:155–71.

    Article  PubMed  CAS  Google Scholar 

  55. Sturm R, Wells KB. How can care for depression become more cost-effective? JAMA. 1995;273:51–8.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Regenstrief Institute for Health Care, 1001 W. 10th St., RG6, 46202-2859, Indianapolis, IN

    Christopher M. Callahan MD, Timothy E. Stump MA, Nancy A. Nienaber MA, Siu L. Hui PhD & William M. Tierney MD

  2. Indiana University Center for Aging Research, USA

    Fredric D. Wolinsky PhD

  3. Richard L. Roudebush VAMC and the Indiana University School of Medicine, Indianapolis, Ind.

    Christopher M. Callahan MD, Siu L. Hui PhD & William M. Tierney MD

  4. Saint Louis University School of Public Health, St. Louis, Mo.

    William M. Tierney MD

Authors
  1. Christopher M. Callahan MD
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  2. Fredric D. Wolinsky PhD
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  3. Timothy E. Stump MA
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  4. Nancy A. Nienaber MA
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  5. Siu L. Hui PhD
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  6. William M. Tierney MD
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The opinions expressed herein are solely those of the authors and not necessarily those of the supporting institutions and agencies.

Dr. Callahan was supported by grant K08 AG00538-04 from the National Institute of Health and a Paul Beeson Physician Faculty Scholar in Aging Research Award. Dr. Wolinsky was supported by grant R37 AG09692 from the National Institutes of Health. Dr. Tierney was supported by grants HS07632 and HS07763 from the Agency for Health Care Policy and Research.

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Callahan, C.M., Wolinsky, F.D., Stump, T.E. et al. Mortality, symptoms, and functional impairment in late-life depression. J GEN INTERN MED 13, 746–752 (1998). https://doi.org/10.1046/j.1525-1497.1998.00226.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1998.00226.x

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