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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60:1168-1172 (2005)
© 2005 The Gerontological Society of America

Anemia Is Associated With Depression in Older Adults: Results From the InCHIANTI Study

Graziano Onder1,2,, Brenda W. J. H. Penninx2, Matteo Cesari1,2, Stefania Bandinelli3, Fulvio Lauretani3, Benedetta Bartali3, Anna Maria Gori4, Marco Pahor2 and Luigi Ferrucci3,5

1 Geriatric Department, Catholic University of the Sacred Heart, Rome, Italy.
2 Sticht Center on Aging, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
3 Geriatric Department, "I Fraticini," National Research Institute, Florence, Italy.
4 Department of Clinical and Surgical Care, Section of Clinical Medicine, Thrombosis Centre, University of Florence, Italy.
5 Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland.

Address correspondence to Graziano Onder, MD, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go Francesco Vito 1, 00168 Rome, Italy. E-mail: graziano_onder{at}

Background. Depression is a common disorder among older adults, and it has been associated with adverse outcomes, including increased risk of morbidity and mortality as well as incomplete or delayed recovery from illness and disability. The objective of this study was to examine whether depressive symptoms and anemia are associated among older adults living in the community.

Methods. We used data from the "Invecchiare in Chianti" (Aging in the Chianti area, InCHIANTI) study, a prospective population-based study of older people living in the community. Anemia was defined by the World Health Organization (WHO) criteria: hemoglobin concentration below 12 g/dl in women and below 13 g/dl in men. Depressive symptoms were measured by using the Center for Epidemiological Studies Depression Scale (CES-D). Participants with a CES-D score ≥16 were considered to be depressed.

Results. Mean age of the 986 participants was 75 years, and 56% were female; 313 (32%) study participants were depressed. Anemia was recorded in 48 of the 313 (15%) participants with depression and in 53 of the 673 (8%) participants without depression (p <.001). After adjusting for potential confounders, depression was associated with a significant higher risk of anemia (odds ratio = 1.93; 95% confidence interval, 1.19–3.13). The risk of anemia progressively and significantly increased with increasing CES-D score (signifying more severe depression). Compared with nondepressed participants (CES-D score <16), the odds ratio for anemia were 1.74, 2.04, and 2.10 for participants with mild (score = 16–20), moderate (score = 21–26), and severe depression (score > 26), respectively (p for linear trend =.01).

Conclusions. Depressive symptoms are associated with anemia in a general population of older persons living in the community.

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J. M. Lyness, A. Niculescu, X. Tu, C. F. Reynolds III, and E. D. Caine
The Relationship of Medical Comorbidity and Depression in Older, Primary Care Patients
Psychosomatics, October 1, 2006; 47(5): 435 - 439.
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