Background

The relationship between depression and increased mortality due to physical illness has been a focus of interest among psychiatrists for many years. Maltzberg (1937) reported that the cardiac death rate among melancholic patients was eight times the rate found in the general population. Avery and Winokur (1976) reported that among 519 depressed patients treated with antidepressants or electroconvulsive therapy, there was a significantly increased death rate among patients who had been inadequately treated for depression. Some of the newest studies using large groups of patients have continued to show an association between depressive disorder or depressive symptoms and increased death rate. Unutzer et al. (2002) reported on a 7-year follow-up of 2558 Medicare recipients age 65 and older. Subjects with mild to moderate depressive symptoms at baseline did not have an increased risk of mortality compared to those without depressive symptoms. The 3% of older adults with the most severe depressive symptoms, however, had significantly increased mortality even after adjusting for demographics, health risk behaviors, and chronic medical disorders. Similarly, Ensinck et al. 2002 in a study in the Netherlands in 2002 reported on 68,965 patients followed for an average of 15 years. Among 1362 depressed patients, 132 had died compared to 4256 deaths among 67,603 non-depressed patients.