Skip to main content Accessibility help
×
×
Home

The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis

  • Jingkai Wei (a1), Ruixue Hou (a2), Xiaotao Zhang (a3), Huiwen Xu (a4), Liyang Xie (a5), Eeshwar K. Chandrasekar (a6), Meiling Ying (a7) and Michael Goodman (a8)...
Abstract
Background

Late-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.

Aim

To estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults.

Method

We conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings.

Results

A total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression.

Conclusion

Late-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.

Declaration of interest

None.

Copyright
Corresponding author
Correspondence: Jingkai Wei, 123 West Franklin Street Suite 420, Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA. Email: jingkai@live.unc.edu
References
Hide All
1Fiske, A, Wetherell, JL, Gatz, M. Depression in older adults. Ann Rev Clin Psychol 2009; 5: 363–89.
2Blazer, DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 2003; 58: 249–65.
3Katon, WJ, Lin, E, Russo, J, Unutzer, J. Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry 2003; 60: 897903.
4Sivertsen, H, Bjorklof, GH, Engedal, K, Selbaek, G, Helvik, AS. Depression and quality of life in older persons: a review. Dement Geriatr Cogn Disord 2015; 40: 311–39.
5Klap, R, Unroe, KT, Unutzer, J. Caring for mental illness in the United States: a focus on older adults. Am J Geriatr Psychiatry 2003; 11: 517–24.
6Blazer, DG. Depression in late life: review and commentary. J Gerontol A 2003; 58: M24965.
7Kennedy, GJ. The geriatric syndrome of late-life depression. Psychiatr Serv 1995; 46: 43–8.
8Alexopoulos, GS, Bruce, ML, Silbersweig, D, Kalayam, B, Stern, E. Vascular depression: a new view of late-onset depression. Dialogues Clin Neurosci 1999; 1: 6880.
9Glassman, AH. Depression and cardiovascular comorbidity. Dialogues Clin Neurosci 2007; 9: 917.
10Saz, P, Dewey, ME. Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int J Geriatr Psychiatry 2001; 16: 622–30.
11Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008–12.
12Wells, G, Shea, B, O'Connell, D, Peterson, J, Welch, V, Losos, M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. The Ottawa Hospital Research Institute, 2000 (http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp).
13Symons, MJ, Moore, DT. Hazard rate ratio and prospective epidemiological studies. J Clin Epidemiol 2002; 55: 893–9.
14DerSimonian, R, Laird, N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–88.
15Reeves, BC, Deeks, JJ, Higgins, JPT, Wells, GA. Chapter 13: Including non-randomized studies. In Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Updated March 2011] (eds Higgins, JPT, Green, S). The Cochrane Collaboration, 2011.
16Duval, S, Tweedie, R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455–63.
17Papazacharias, A, Logroscino, G, Barulli, MR, Nardini, M. Late life depression and late onset depression: are the same clinical and pathopsysiological picture? Psychiatr Danub 2010; 22: S10810.
18Sheline, YI, Pieper, CF, Barch, DM, Welsh-Boehmer, K, McKinstry, RC, MacFall, JR, et al. Support for the vascular depression hypothesis in late life depression: results from a two site prospective antidepressant treatment trial. Arch Gen Psychiatry 2010; 67: 277–85.
19Taylor, WD, Aizenstein, HJ, Alexopoulos, GS. The vascular depression hypothesis: mechanisms linking vascular disease with depression. Mol Psychiatry 2013; 18: 963–74.
20Teng, PR, Yeh, CJ, Lee, MC, Lin, HS, Lai, TJ. Change in depressive status and mortality in elderly persons: results of a national longitudinal study. Arch Gerontol Geriatr 2013; 56: 244–9.
21Penninx, BW, Guralnik, JM, Mendes de Leon, CF, Pahor, M, Visser, M, Corti, MC, et al. Cardiovascular events and mortality in newly and chronically depressed persons >70 years of age. Am J Cardiol. 1998; 81: 988–94.
22Khawaja, IS, Westermeyer, JJ, Gajwani, P, Feinstein, RE. Depression and coronary artery disease: the association, mechanisms, and therapeutic implications. Psychiatry 2009; 6: 3851.
23Verger, P, Lions, C, Ventelou, B. Is depression associated with health risk-related behaviour clusters in adults? Eur J Public Health 2009; 19: 618–24.
24Carney, RM, Freedland, KE, Eisen, SA, Rich, MW, Jaffe, AS. Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychol 1995; 14: 8890.
25Goodwin, GM. Depression and associated physical diseases and symptoms. Dialogues Clin Neurosci 2006; 8: 259–65.
26Morimoto, SS, Alexopoulos, GS. Immunity, aging, and geriatric depression. Psychiatr Clin North Am 2011; 34: 437–49.
27Aziz, R, Steffens, DC. What are the causes of late-life depression? Psychiatr Clin North Am 2013; 36: 497516.
28Allan, CL, Ebmeier, KP. Review of treatment for late-life depression. Adv Psychiatr Treat 2018; 19: 302–9.
29Chang, S-C, Pan, A, Kawachi, I, Okereke, OI. Risk factors for late-life depression: a prospective cohort study among older women. Prev Med 2016; 91: 144–51.
30Hall, CA, Reynolds-Iii, CF. Late-life depression in the primary care setting: challenges, collaborative care, and prevention. Maturitas 2014; 79: 147–52.
31Kamphuis, MH, Kalmijn, S, Tijhuis, MA, Geerlings, MI, Giampaoli, S, Nissinen, A, et al. Depressive symptoms as risk factor of cardiovascular mortality in older European men: the Finland, Italy and Netherlands Elderly (FINE) study. Eur J Cardiovasc Prev Rehabil 2006; 13: 199206.
32Sun, WJ, Xu, L, Chan, WM, Lam, TH, Schooling, CM. Are depressive symptoms associated with cardiovascular mortality among older Chinese: a cohort study of 64,000 people in Hong Kong? Am J Geriatr Psychiatry 2013; 21: 1107–15.
33Lara, E, Haro, JM, Tang, MX, Manly, J, Stern, Y. Exploring the excess mortality due to depressive symptoms in a community-based sample: the role of Alzheimer's Disease. J Affect Disord 2016; 202: 163–70.
34Piña-Escudero, SD, Navarrete-Reyes, AP, Ávila-Funes, JA. Depressive symptoms increase the risk of mortality in older Mexican community-dwelling adults. J Am Geriatr Soc 2011; 59: 2171–2.
35Gallo, JJ, Bogner, HR, Morales, KH, Post, EP, Lin, JY, Bruce, ML. The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial. Ann Intern Med 2007; 146: 689–98.
36Gallo, JJ, Morales, KH, Bogner, HR, Raue, PJ, Zee, J, Bruce, ML, et al. Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ 2013; 346: f2570.
37Andrews, PW, Thomson, JA, Amstadter, A, Neale, MC. Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Front Psychol 2012; 3: 117.
38Aizenstein, HJ, Baskys, A, Boldrini, M, Butters, MA, Diniz, BS, Jaiswal, MK, et al. Vascular depression consensus report – a critical update. BMC Med 2016; 14: 161.
39McGovern, AR, Kiosses, DN, Raue, PJ, Wilkins, VM, Alexopoulos, GS. Psychotherapies for late-life depression. Psychiatr Ann 2014; 44: 147–52.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Wei et al. supplementary material
Wei et al. supplementary material 1

 Word (214 KB)
214 KB
WORD
Supplementary materials

Wei et al. supplementary material
Wei et al. supplementary material 2

 Word (25 KB)
25 KB
WORD
Supplementary materials

Wei et al. supplementary material
Wei et al. supplementary material 3

 Word (60 KB)
60 KB

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

The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis

  • Jingkai Wei (a1), Ruixue Hou (a2), Xiaotao Zhang (a3), Huiwen Xu (a4), Liyang Xie (a5), Eeshwar K. Chandrasekar (a6), Meiling Ying (a7) and Michael Goodman (a8)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *