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Depression and mortality in a high-risk population

II-Year follow-up of the Medical Research Council Elderly Hypertension Trial

Division of Psychiatry, University of Auckland, New Zealand

MATTHEW HOTOPF, PhD

Department of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine and Institute of Psychiatry, London, UK

MARTIN PRINCE, MD

Section of Epidemiology, Institute of Psychiatry, London, UK

Correspondence: Dr Melanie Abas, Research and Audit in Mental Health Services Team, Tiaho Mai, Middlemore Hospital, South Auckland, New Zealand. E-mail: m.abas{at}auckland.ac.nz

Declaration of interest Funded by the UK Medical Research Council. M.A. has received an educational award from Eli Lilly Ltd.

Background It is not clear whether the increased mortality associated with depression can be explained by the effects of potential confounding variables.

Aims To measure the effect of depression on mortality after controlling for cognitive decline, cardiovascular risk factors and antidepressant use.

Method A prospective cohort study derived from data from a multi-centre randomised controlled trial of moderate hypertension. A total of 2584 participants, aged 65-75 years at study entry, were followed up for 11 years.

Results Depression on the SelfCARE—D scale was associated with mortality after controlling for gender. After controlling for cardiovascular risk factors, cognitive decline and antidepressant use, depression continued to have a modest effect (hazard ratio=1.43; 95% C11.03-1.98). Depression in males and in people aged under 70 years significantly increased the risk of death.

Conclusions Depression was associated with mortality only after controlling for gender. There was a modest but robust association between depression and mortality that was not explained by confounding by cardiovascular risk factors, cognitive decline or history of antidepressant use.

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