Depression, non-fatal stroke and all-cause mortality in old age: A prospective cohort study of primary care patients

JOURNAL OF AFFECTIVE DISORDERS

卷:150

Article

Kohler, Sebastian¹  Verhey, Frans¹  Weyerer, Siegfried²  Wiese, Birgitt³  Heser, Kathrin⁴  Wagner, Michael⁴  Pentzek, Michael⁵  Kohler, Mirjam⁶  Bachmann, Cadja⁶  Heller, Steffi G. Riedel⁷  Luppa, Melanie⁷  Eifflaender-Gorfer, Sandra²  Werle, Jochen²  Bickel, Horst⁸  Mosh, Edelgard⁸  Konig, Hans-Helmut⁹  Brettschneider, Christian⁹  Scherer, Martin⁶  Maier, Wolfgang^4,10 

[1] Maastricht Univ, Ctr Med, Alzheimer Ctr Limburg, Sch Mental Hlth & Neurosci,Dept Psychiat & Neurop, Maastricht, Netherlands

[2] Mannheim Heidelberg Univ, Fac Med, Cent Inst Mental Hlth, Mannheim, Germany

[3] Hannover Med Sch, Inst Biometr, Hannover, Germany

[4] Univ Bonn, Dept Psychiat, Bonn, Germany

[5] Univ Dusseldorf, Fac Med, Dept Gen Practice, D-40225 Dusseldorf, Germany

[6] Univ Med Ctr Hamburg Eppendorf, Inst Primary Med Care, Hamburg, Germany

[7] Univ Leipzig, Inst Social Med Ocupational Hlth & Publ, D-04109 Leipzig, Germany

[8] Tech Univ Munich, Dept Psychiat, D-80290 Munich, Germany

[9] Univ Med Ctr Hamburg Eppendorf, Dept Med Sociol & Hlth Econ, Hamburg, Germany

[10] German Ctr Neurodegenerat Dis, Bonn, Germany

关键词: Cerebrovascular accident;    Depression;    Epidemiology;    Prevention;    Risk factors;    Mortality;   

DOI  :  10.1016/j.jad.2013.02.020

来源: Elsevier

【 摘 要 】

Background: Depression is a risk factor for stroke and mortality but whether this also holds into old age is uncertain. We therefore studied the association of depression with the risk for non-fatal stroke and all-cause mortality in very old age. Methods: A representative sample of 3085 primary care patients aged >= 75 years were serially assessed during a 6-year follow-up. The relation between depression (Geriatric Depression Scale >6, n=261) and relevant covariates including vascular risk factors and disease, functional and mild cognitive impairment and ApoE genotype on primary care givers information of incident stroke (n=209) and mortality (n=647) were assessed by Cox regression and by competing risk regressions. Results: Depression was not independently associated with incident stroke in fully adjusted models that treated death as the competing event (subdistribution hazard ratio=0.80, 95% confidence interval =0.47 to 1.36). The risk associated with depression was similar for men and women, and for age groups 75-79, 80-84 and >= 85 years. In contrast, depression increased all-cause mortality rates, even after adjusting for a range of confounders (hazard ratio =1.31, 95% confidence interval =1.03 to 1.67). Limitations: We have no information on past depressive episodes and cause of death. Conclusions: In contrast to reports in younger populations, depression does not appear to increase stroke risk among the old and very old, but continuous to be a risk factor for all-cause mortality. (C) 2013 Elsevier B.V. All rights reserved.

【 授权许可】

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