Abstract
Objectives
Individuals with late-life depression (LLD) may have shorter survival, but there is
a lack of findings in population-based settings about health-related outcomes of LLD
and its subtypes: early-onset depression (EOD) and late-onset depression (LOD). We
aimed to evaluate the risk of all-cause mortality of individuals with LLD and its
subtypes in an older population-based cohort. Moreover, we investigated whether inflammatory,
cognitive, genetic features and multimorbidity could modify the effect of this association.
Design
Longitudinal population-based study with 8-year follow-up.
Setting and Participants
We analyzed data on a sample of 1479 participants, all aged >65 years, in the Salus
in Apulia Study.
Methods
LLD was diagnosed through DSM-IV-TR criteria and LOD and EOD according to the age
of onset. Multimorbidity status was defined as the copresence of 2 or more chronic
diseases.
Results
The overall prevalence of LLD in this older sample from Southern Italy was 10.2%,
subdivided into 3.4% EOD and 6.8% LOD. In multivariable Cox models adjusted for age,
gender, education, global cognition, apolipoprotein E ε4 allele, physical frailty,
interleukin-6, and multimorbidity, LLD showed a greater risk of all-cause mortality.
LOD differed from EOD regarding gender, education, cognitive dysfunctions, and diabetes
mellitus. There was a significantly increased risk of all-cause mortality for participants
with LOD (hazard ratio:1.99; 95% CI 1.33–2.97) in the time of observation between
enrollment date and death date (7.31 ± 2.17 months).
Conclusions and Implication
In older age, individuals with LOD but not with EOD had a significantly decreased
survival, probably related to increased inflammation, multimorbidity, and cognitive
impairments.
Keywords
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References
- Mortality associated with mental disorders and comorbid general medical conditions.JAMA Psychiatr. 2022; 79: 444-453
- Relationship of depression to medical illness.J Affect Dis. 1981; 3: 111-121
- Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases.J Gerontol A Biol Sci Med Sci. 2014; 69: S4-S9
- Depression, antidepressant use and mortality in later life: The health in men study.PLoS One. 2010; 5: e11266
- Depression, non-fatal stroke and all-cause mortality in old age: A prospective cohort study of primary care patients.J Affect Disord. 2013; 150: 63-69
- The association between depressive symptoms and mortality among Chinese elderly: A Hong Kong cohort study.J Gerontol A Biol Sci Med Sci. 2011; 66: 459-466
- Physical Frailty, multimorbidity, and all-cause mortality in an older population from southern Italy: Results from the Salus in Apulia Study.J Am Med Dir Assoc. 2021; 22: 598-605
- Age- and gender-specific prevalence of depression in latest-life–systematic review and meta-analysis.J Affect Disord. 2012; 136: 212-221
- The diagnostic accuracy of late-life depression is influenced by subjective memory complaints and educational level in an older population in Southern Italy.Psychiatry Res. 2022; 308: 114346
- Late-life depression, mild cognitive impairment, and dementia: possible continuum?.Am J Geriatr Psychiatr. 2010; 18: 98-116
- Distinct epigenetic signatures between adult-onset and late-onset depression.Sci Rep. 2021; 11: 2296
- Social determinants of late-life depression epigenetics.Epigenomics. 2020; 12: 559-562
- The effect of gender and age at onset of depression on mortality.J Clin Psychiatry. 1997; 58: 355-360
- Mortality and late-onset affective disorder.J Affect Disord. 1983; 5: 297-304
- Social dysfunction in older age and relationships with cognition, depression, and apathy: The GreatAGE Study.J Alzheimers Dis. 2018; 65: 989-1000
- Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV).American Psychiatric Press, 1996
- The American Psychiatric Association practice guidelines for the psychiatric evaluation of adults: Guideline V. Assessment of cultural factors. Focus.Am Psychiatr Publ. 2020; 18: 71-74
- Simple and effective determination of apolipoprotein E genotypes by positive/negative polymerase chain reaction products.Diagn Mol Pathol. 2006; 15: 180-185
- Development and validation of a geriatric depression screening scale: A preliminary report.J Psychiatr Res. 1982–1983; 17: 37-49
- “Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- The need to report effect size estimates revisited. An overview of some recommended measures of effect size.Trends Sport Sci. 2014; 1: 19-25
- A systematic review of the mortality of depression.Psychosom Med. 1999; 61: 6-17
- Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses.Am J Psychiatry. 2014; 171: 453-462
- A reassessment of the relationship between depression and all-cause mortality in 3,604,005 participants from 293 studies.World Psychiatr. 2017; 16: 219-220
- Morbidity risks in subtypes of unipolar depressive illness: differences between early and late onset forms.Br J Psychiatry. 1981; 139: 463-466
- MRI and neuropsychological differences in early- and late-life-onset geriatric depression.Neurology. 1996; 46: 1567-1574
- Hippocampal morphology and distinguishing late-onset from early-onset elderly depression.Am J Psychiatry. 2008; 165: 229-237
- Depression in dementia or dementia in Depression? Systematic review of studies and hypotheses.Curr Alzheimer Res. 2020; 17: 16-28
- Longitudinal cognitive outcomes of clinical phenotypes of late-life depression.Am J Geriatr Psychiatry. 2017; 25: 1123-1134
- Depression, frailty, and all-cause mortality: A cohort study of men older than 75 years.J Am Med Dir Assoc. 2015; 16: 296-300
- Further evidence of peripheral inflammatory markers involvement in late-onset depression and cognitive decline.Am J Geriatr Psychiatry. 2022; 30: 701-702
- Molecular basis of late-life depression.Int J Mol Sci. 2021; 22: 7421
- Processed meat consumption and the risk of incident late-onset depression: A 12-year follow-up of the Salus in Apulia Study.Age Ageing. 2022; 51: afab257
- Peripheral inflammatory parameters in late-life depression: A systematic review.Int J Mol Sci. 2016; 17: 2022
- No increase in inflammation in late-life major depression screened to exclude physical illness.Transl Psychiatry. 2022; 12: 118
- Aging with multimorbidity: A systematic review of the literature.Ageing Res Rev. 2011; 10: 430-439
- Multimorbidity and depression among older adults in India: Mediating role of functional and behavioural health.PLoS One. 2022; 17: e0269646
- Is depression associated with microvascular disease in patients with type 2 diabetes?.Depress Anxiety. 2008; 25: E158-E162
- Late-life depression and cognitive function among older adults in the U.S.: The National Health and Nutrition Examination Survey, 2011–2014.J Psychiatr Res. 2019; 111: 30-35
- Metabolic syndrome: Differences between psychiatric and internal medicine patients.Int J Psychiatry Med. 2013; 45: 203-226
- Physical exercise for late life depression: effects on cognition and disability.Int Psychogeriatr. 2017; 29: 1105-1112
- Risk of late-onset depression and cognitive decline: Results from inflammatory proteome analyses in a prospective population-based cohort study.Am J Geriatr Psychiatry. 2022; 30: 689-700
- The depressed frail phenotype: The clinical manifestation of increased biological aging.Am J Geriatr Psychiatry. 2016; 24: 1084-1094
- Different cognitive frailty models and health- and cognitive-related outcomes in older age: from epidemiology to prevention.J Alzheimers Dis. 2018; 62: 993-1012
- Apolipoprotein E genotype, inflammatory biomarkers, and non-psychiatric multimorbidity contribute to the suicidal ideation phenotype in older age. The Salus in Apulia Study.J Affect Disord. 2022; 319: 202-212
Article info
Publication history
Published online: December 31, 2022
Publication stage
In Press Corrected ProofFootnotes
This study was funded by the Italian Ministry of Health with a “Ricerca Corrente 2019” Grant. The work reported in this publication was granted by the Italian Ministry of Health, under the Studies on Aging Network, at Italian Research Hospitals (IRCCS).
The authors declare no conflicts of interest.
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© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
