Rachel A Murphy1, Ashley K Hagaman2, Ilse Reinders3, Jeremy A Steeves4, Anne B Newman5, Susan M Rubin6, Suzanne Satterfield7, Stephen B Kritchevsky8, Kristine Yaffe6, Hilsa N Ayonayon6, Daniel S Nagin9, Eleanor M Simonsick10, Brenda W J H Penninx11, Tamara B Harris12. 1. School of Population and Public Health, University of British Columbia, Vancouver, Canada. Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland. rachel.murphy@ubc.ca. 2. School of Human Evolution and Social Change, Arizona State University, Tempe. 3. Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland. Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands. 4. Cancer Prevention Fellowship Program, National Cancer Institute/Division of Cancer Control and Population Sciences, Rockville, Maryland. 5. Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pennsylvania. 6. Department of Psychiatry, University of California at San Francisco. 7. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis. 8. Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina. 9. Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania. 10. Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland. 11. Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands. 12. Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland.
Abstract
BACKGROUND: Depression and disability are closely linked. Less is known regarding clinical and subclinical depressive symptoms over time and risk of disability and mortality. METHODS: Responses to the Center for Epidemiologic Studies Short Depression scale (CES-D10) were assessed over a 4-year period in men (n = 1032) and women (n = 1070) aged 70-79 years initially free from disability. Depressive symptom trajectories were defined with group-based models. Disability (2 consecutive reports of severe difficulty walking one-quarter mile or climbing 10 steps) and mortality were determined for 9 subsequent years. Hazard ratios (HRs) were estimated using Cox proportional hazards adjusted for covariates. RESULTS: Three trajectories were identified: persistently nondepressed (54% of men, 54% of women, mean baseline CES-D10: 1.16 and 1.46), mildly depressed and increasing (40% of men, 38% of women, mean baseline CES-D10: 3.60 and 4.35), and depressed and increasing (6% of men, 8% of women, mean baseline CES-D10: 7.44 and 9.61). Disability and mortality rates per 1,000 person years were 41.4 and 60.3 in men and 45.8 and 41.9 in women. Relative to nondepressed, men in the mildly depressed (HR = 1.45, 95% confidence interval [CI] 1.11-1.89) and depressed trajectories (HR = 2.12, 95% CI 1.33-3.38) had increased disability; women in the depressed trajectory had increased disability (HR = 2.02, 95% CI 1.37-2.96). Men in the mildly depressed (HR = 1.24, 95% CI 1.01-1.52) and depressed trajectories (HR = 1.63, 95% CI 1.10-2.41) had elevated mortality risk; women exhibited no mortality risk. CONCLUSIONS: Trajectories of depressive symptoms without recovery may predict disability and mortality in apparently healthy older populations, thus underscoring the importance of monitoring depressive symptoms in geriatric care. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.
BACKGROUND:Depression and disability are closely linked. Less is known regarding clinical and subclinical depressive symptoms over time and risk of disability and mortality. METHODS: Responses to the Center for Epidemiologic Studies Short Depression scale (CES-D10) were assessed over a 4-year period in men (n = 1032) and women (n = 1070) aged 70-79 years initially free from disability. Depressive symptom trajectories were defined with group-based models. Disability (2 consecutive reports of severe difficulty walking one-quarter mile or climbing 10 steps) and mortality were determined for 9 subsequent years. Hazard ratios (HRs) were estimated using Cox proportional hazards adjusted for covariates. RESULTS: Three trajectories were identified: persistently nondepressed (54% of men, 54% of women, mean baseline CES-D10: 1.16 and 1.46), mildly depressed and increasing (40% of men, 38% of women, mean baseline CES-D10: 3.60 and 4.35), and depressed and increasing (6% of men, 8% of women, mean baseline CES-D10: 7.44 and 9.61). Disability and mortality rates per 1,000 person years were 41.4 and 60.3 in men and 45.8 and 41.9 in women. Relative to nondepressed, men in the mildly depressed (HR = 1.45, 95% confidence interval [CI] 1.11-1.89) and depressed trajectories (HR = 2.12, 95% CI 1.33-3.38) had increased disability; women in the depressed trajectory had increased disability (HR = 2.02, 95% CI 1.37-2.96). Men in the mildly depressed (HR = 1.24, 95% CI 1.01-1.52) and depressed trajectories (HR = 1.63, 95% CI 1.10-2.41) had elevated mortality risk; women exhibited no mortality risk. CONCLUSIONS: Trajectories of depressive symptoms without recovery may predict disability and mortality in apparently healthy older populations, thus underscoring the importance of monitoring depressive symptoms in geriatric care. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.
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