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Depression, Cardiovascular Disease, Diabetes, and Two-Year Mortality Among Older, Primary-Care Patients

Received November 29, 2004; revised January 25, 2004; accepted February 10, 2005. From the Dept. of Family Practice and Community Medicine (JJG, HRB), the Center for Clinical Epidemiology and Biostatistics, School of Medicine, Univ. of Pennsylvania, Philadelphia, PA (JJG, HRB, KHM, TTH), the Depts. of Medicine and Psychiatry, Univ. of Pittsburgh School of Medicine, Pittsburgh, PA (EPP), and the Dept. of Psychiatry, Weill Medical College of Cornell University, White Plains, NY (MLB). Send correspondence and reprint requests to Joseph J. Gallo, M.D., M.P.H., Dept. of Family Practice and Community Medicine, School of Medicine, Univ. of Pennsylvania, 3400 Spruce Street, 2 Gates Bldg., Philadelphia, PA 19104. e-mail: galloj{at}uphs.upenn.edu
© 2005 American Association for Geriatric Psychiatry

Objective: Depression is a major contributor to death and disability, but few follow-up studies of depression have been carried out in the primary-care setting. The authors sought to assess whether depression in older patients is associated with increased mortality after a 2-year follow-up interval and to estimate the population-attributable fraction (PAF) of depression on mortality in older primary-care patients. Methods: Longitudinal cohort analysis was carried out in 20 primary-care practices. Participants were identified though a two-stage, age-stratified (60–74 or 75+) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of screened-negative patients. In all, 1,226 persons were assessed at baseline. Vital status at 2 years was the outcome of interest. Results: Of 1,226 persons in the sample, 598 were classified as depressed. After 2 years, 64 persons had died. Persons with depression at baseline were more likely to die at the end of the 2-year follow-up interval than were persons without depression, even after accounting for potentially influential covariates such as whether the participant reported a history of myocardial infarction (MI) or diabetes. Conclusions: Among older, primary-care patients over the course of a 2-year follow-up interval, depression contributed as much to mortality as did MI or diabetes.

Key Words: Depression • Cardiovascular Disease • Diabetes • Mortality • Risk Factors

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