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Does Depression in Older Medical Inpatients Predict Mortality?

Departments of ¹ Clinical Epidemiology and Community Studies and ³ Psychiatry, St. Mary's Hospital, Montreal, Quebec, Canada.
Departments of ² Epidemiology, Biostatistics, and Occupational Health, ⁴ Psychiatry, and ⁷ Family Medicine, McGill University, Montreal, Quebec, Canada.
⁵ Services, Policy and Population Health Research Theme, Douglas Hospital Research Centre, Montreal, Quebec, Canada.
⁶ Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada.

Address correspondence to Jane McCusker, MD, DrPH, Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, 3830 Lacombe, Montreal (Quebec), H3T 1M5. E-mail: jane.mccusker{at}mcgill.ca or Martin Cole, MD, FRCP(C), Psychiatry Department, St. Mary's Hospital, 3830 Lacombe, Montreal (Quebec), H3T 1M5. E-mail: martin.cole{at}ssss.gouv.qc.ca

Background. Previous studies of the effect of depression on mortality among older medical inpatients have yielded inconsistent results. We examined the effects on mortality of both a diagnosis of depression at hospital admission and a history of previous depression, taking into account potential sources of bias (sample selection and confounding).

Methods. Medical inpatients aged 65+ with at most mild cognitive impairment were recruited at two Montreal hospitals and were screened for depression. All those with a diagnosis of major or minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria) and a random sample of nondepressed patients were invited to participate. Baseline data included: history of previous depression, severity of physical illness, comorbidity, and health services utilization. Cox proportional hazards methods were used to analyze survival during the 16- to 52-month follow-up period.

Results. Five hundred patients were enrolled; 116 (23.2%) had a history of previous depression. After adjustment for demographic factors, physical illness, cognitive impairment, and prior service utilization, the only depression group with significantly different mortality was patients with both current major depression and a history of depression, who had lower mortality than all other patient groups (hazard ratio 0.42; 95% confidence interval: 0.25, 0.70).

Conclusions. Among patients with no history of depression, a diagnosis of depression was not associated with mortality after adjustment for confounding by physical illness and other factors. Coincident major depression and history of depression was associated with decreased mortality.