1  Abstract

No recent attempt has been made to synthesise information on mortality and depression despite the theoretical and practical interest in the topic. Our objective was to estimate in the older population the influence on mortality of depression and depressive symptoms
Data sources were: Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from health care facilities were excluded. Effect sizes were extracted from the papers and if they were not included in the published papers effect sizes were calculated if possible. No attempt was made to contact authors for missing data.
We found 21 reports on 23 cohorts using depression diagnosis. For 15 of these odds ratios were pooled using the Greenland confidence interval based method giving an estimated odds ratio for mortality with depression of 1.73 (95% CI 1.53 to 1.95). A fixed effects meta-regression of these studies suggested that longer follow-up predicted smaller effect sizes (log odds ratios) -0.096 per year (95% CI -0.179 to -0.014) There is a weak suggestion of a reduced effect of depression on mortality for women. We were unable to pool effect sizes from the 17 studies using symptom totals and scales, nor from 8 studies of specific symptoms.
The studies show that diagnosed depression in community resident older people is associated with increased mortality. The picture on sex differences is still unclear.

2  Key points

  • There is an increased risk of mortality in depression in older age
  • The role of physical illness seems unclear

  • The differential mortality decreases as time goes by.

  • We do not know what people with depression die of.

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On 9 Jul 2001, 16:32.