Holwerda Tjalling J, Schoevers Robert A, Dekker Jack, Deeg Dorly J H, Jonker Cees, Beekman Aartjan T F
Department of Psychiatry, Mentrum Mental Health Care, Amsterdam, The Netherlands.
Int J Geriatr Psychiatry. 2007 Mar;22(3):241-9. doi: 10.1002/gps.1669.
The association between depression and an increased risk of death in elderly persons has been established in both clinical and community studies. Co-occurrence of depression and generalized anxiety has been shown to represent more severe and more chronic psychopathology. However, little is known about the relation between generalized anxiety disorder, mixed anxiety-depression (generalized anxiety disorder and depression) and excess mortality in the elderly.
To investigate whether generalized anxiety and mixed anxiety-depression are associated with mortality.
Generalized anxiety disorder, mixed anxiety-depression and depression were assessed in 4051 older persons with a ten-year follow-up of community death registers. The mortality risk of generalized anxiety, depression and mixed anxiety-depression was calculated after adjustment for demographic variables, physical illness, functional disabilities and social vulnerability.
In generalized anxiety disorder and mixed anxiety-depression no significant excess mortality was found. In depression a significant excess mortality was found in men [HR 1.44 (1.09-1.89)] but not in women [HR 1.04 (0.87-1.24)] after adjustment for the different variables.
In elderly persons depression increases the risk of death in men. Neither generalized anxiety nor mixed anxiety-depression are associated with excess mortality. Generalized anxiety disorder may even predict less mortality in depressive elderly people. The relation between generalized anxiety disorder and its possibly protective effect on mortality has to be further explored.
临床研究和社区研究均已证实老年人中抑郁症与死亡风险增加之间存在关联。抑郁症与广泛性焦虑症同时出现已被证明代表更严重、更慢性的精神病理学状况。然而，关于广泛性焦虑症、混合性焦虑抑郁（广泛性焦虑症和抑郁症）与老年人超额死亡率之间的关系，人们所知甚少。
调查广泛性焦虑症和混合性焦虑抑郁是否与死亡率相关。
对4051名老年人进行广泛性焦虑症、混合性焦虑抑郁和抑郁症评估，并对社区死亡登记册进行为期十年的随访。在对人口统计学变量、身体疾病、功能残疾和社会脆弱性进行调整后，计算广泛性焦虑症、抑郁症和混合性焦虑抑郁的死亡风险。
在广泛性焦虑症和混合性焦虑抑郁中未发现显著的超额死亡率。在对不同变量进行调整后，抑郁症在男性中发现显著的超额死亡率[风险比1.44（1.09 - 1.89）]，但在女性中未发现[风险比1.04（0.87 - 1.24）]。
在老年人中，抑郁症会增加男性的死亡风险。广泛性焦虑症和混合性焦虑抑郁均与超额死亡率无关。广泛性焦虑症甚至可能预示抑郁老年人的死亡率较低。广泛性焦虑症与其对死亡率可能的保护作用之间的关系有待进一步探索。
