Institute of Acupuncture and Anesthesia, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201314, China.
South London and Maudsley NHS Foundation Trust, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
J Affect Disord. 2020 Apr 1;266:695-701. doi: 10.1016/j.jad.2020.01.021. Epub 2020 Jan 10.
Late-life depression (LLD) is associated with an increased mortality risk in the general older population. It remains however unclear which signs or symptoms are predictive of mortality in those suffering from LLD.
Patients aged 65 years or older with depressive disorder diagnosed in Southeast London between January 2008 and December 2017.
We assembled patients diagnosed with late-life depression from the Maudsley Biomedical Research Centre Case Register, which is linked to national mortality data. Using depression diagnosis as index date, we followed patients until death or censoring point. Sociodemographic data, scores of Health of the Nation Outcome Scales (HoNOS65+), which include a physical illness scale, profiles of depressive symptoms, and psychotropic medications were extracted and modeled in multivariable survival analyses to determine predictors of mortality.
Of 4,243 patients with LLD (mean age 77.0 years; 61.2% female), 2,327 (54.8%) died over a median follow-up time of 3.5 years. In multivariable Cox regression models, an increased risk of all-cause mortality was associated with older age, cognitive problems, physical illness/disability, impaired activities of daily living, apathy, lack of appetite and mirtazapine prescription; conversely, female gender, non-white ethnicity, guilt feelings, tearfulness, impaired concentration, disturbed sleep and delusions were associated with lower mortality risk.
Besides demographic factors, physical health, functioning and cognition, different depressive symptoms were significantly associated with the prognosis of LLD. Elderly patients presenting with depressive symptoms predicting higher mortality risk should be examined and followed more closely.
老年期抑郁症（LLD）与普通老年人群的死亡率增加有关。然而，对于患有 LLD 的患者，哪些症状或体征可以预测死亡率仍不清楚。
2008 年 1 月至 2017 年 12 月期间在伦敦东南部被诊断为老年期抑郁症的 65 岁及以上患者。
我们从与国家死亡率数据相关的莫兹利生物医学研究中心病例登记处中汇集了被诊断为老年期抑郁症的患者。使用抑郁症诊断作为索引日期，我们对患者进行随访，直到死亡或截止点。提取并在多变量生存分析中对社会人口统计学数据、国家卫生结果量表（HoNOS65+）评分进行建模，该量表包括生理疾病量表、抑郁症状特征和精神药物，以确定死亡率的预测因素。
在 4243 例 LLD 患者（平均年龄 77.0 岁；61.2%为女性）中，有 2327 例（54.8%）在中位数为 3.5 年的随访期间死亡。在多变量 Cox 回归模型中，全因死亡率的风险增加与年龄较大、认知问题、身体疾病/残疾、日常生活活动受损、淡漠、食欲不振和米氮平处方有关；相反，女性、非白种人、内疚感、流泪、注意力受损、睡眠障碍和妄想与较低的死亡率风险相关。
除了人口统计学因素外，身体健康、功能和认知，不同的抑郁症状与 LLD 的预后显著相关。出现预测死亡率较高的抑郁症状的老年患者应接受更仔细的检查和随访。
