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The Cardiovascular Health Study

Richard Schulz, PhD; Scott R. Beach, PhD; Diane G. Ives, MPH; Lynn M. Martire, PhD; Abraham A. Ariyo, MD, MPH; Willem J. Kop, PhD

Arch Intern Med. 2000;160:1761-1768.

Background  Studies of the association between depressive symptoms and mortality in elderly populations have yielded contradictory findings. To address these discrepancies, we test this association using the most extensive array of sociodemographic and physical health control variables ever studied, to our knowledge, in a large population-based sample of elderly individuals.

Objective  To examine the relation between baseline depressive symptoms and 6-year all-cause mortality in older persons, systematically controlling for sociodemographic factors, clinical disease, subclinical disease, and health risk factors.

Methods  A total of 5201 men and women aged 65 years and older from 4 US communities participated in the study. Depressive symptoms and 4 categories of covariates were assessed at baseline. The primary outcome measure was 6-year mortality.

Results  Of the 5201 participants, 984 (18.9%) died within 6 years. High baseline depressive symptoms were associated with a higher mortality rate (23.9%) than low baseline depression scores (17.7%) (unadjusted relative risk [RR], 1.41; 95% confidence interval [CI], 1.22-1.63). Depression was also an independent predictor of mortality when controlling for sociodemographic factors (RR, 1.43; 95% CI, 1.23-1.66), prevalent clinical disease (RR, 1.25; 95% CI, 1.07-1.45), subclinical disease indicators (RR, 1.35; 95% CI, 1.15-1.58), or biological or behavioral risk factors (RR, 1.42; 95% CI, 1.22-1.65). When the best predictors from all 4 classes of variables were included as covariates, high depressive symptoms remained an independent predictor of mortality (RR, 1.24; 95% CI, 1.06-1.46).

Conclusions  High levels of depressive symptoms are an independent risk factor for mortality in community-residing older adults. Motivational depletion may be a key underlying mechanism for the depression-mortality effect.

From the Department of Psychiatry (Drs Schulz and Martire), the University Center for Social and Urban Research (Drs Schulz, Beach, and Martire), and the Department of Epidemiology, Graduate School of Public Health (Ms Ives), University of Pittsburgh, Pittsburgh, Pa; the Department of Cardiology, University of California, Davis Medical Center, Sacramento (Dr Ariyo); and the Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, and the Division of Cardiology, Georgetown University Medical Center, Washington, DC (Dr Kop).

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