Evidence has been building for several decades that depression can increase the elderly’s risk of dying. Now this link has been tightened a notch further by a study reported in the October Archives of General Psychiatry by a team of Dutch scientists.

Brenda W.J.H. Penninx, Ph.D., an epidemiologist with Vrije University in Amsterdam, and her coworkers examined the incidence of either major depression or minor depression among some 3,000 men and women ages 55 to 85 years old living in various areas throughout the Netherlands. Death certificates for all subjects who died between the start of the study in 1993 and the end of the study in 1997 were likewise obtained. After adjusting for possibly confounding socioeconomic factors such as age, sex, education, smoking, alcohol consumption, body mass index, physical activity, and chronic disease, the researchers found that major depression was associated with a 1.83-fold higher death risk in both men and women, and minor depression with a 1.80-fold higher death risk in men.

"It is an interesting finding," said Mustafa M. Husain, M.D., a psychiatrist with the University of Texas Southwestern Medical Center in Dallas and chair of the APA Committee on Access and Effectiveness of Psychiatric Services for the Elderly. Internists and cardiologists who deal with the elderly should be made aware of such data, he believes.

Certainly this study has implications for physicians who care for the elderly, agrees Scott Spier, M.D., chief of the division of psychiatry at Mercy Medical Center in Baltimore and a physician with a special interest in geriatric psychiatry. They should do their best to see that depressed older people, especially those in nursing homes, get the antidepressant medications they need. Being sad because you are stuck in a nursing home, he stresses, is not the same as being depressed.

George Dyck, M.D., a psychiatrist with the University of Kansas in Wichita and on the APA Committee on Long-Term Care and Treatment for the Elderly, views the Dutch investigation from still another perspective. Although seniors are more likely to talk about their depressions than they used to, he points out, older men are still more reluctant to do so than older women are. Thus the reason the Dutch investigators found that minor depression increased mortality risk among older men but not among older women, he speculates, may have been due to a number of older men playing down their depressions and thus being categorized as "minor" depressives when they actually belonged to the "major depression" category.

Still unclear, however, is why seniors are more likely to die when they are depressed than when they are not. The increased risk of death among depressives in the Dutch study could not be attributed to suicide. In fact, about a half of those with major depression succumbed to cardiovascular disease and a fair number of those with minor depression to respiratory disease. But might the causes lie still deeper in the human mind and body—might depression alter certain endocrinologic and immune pathways that predispose to specific diseases?

Mark Goulston, M.D., a Los Angeles-based psychiatrist and a senior psychiatrist at <www.Lifescape.com>, the primary behavioral and mental health resource to <www.Dr.Koop.com>, thinks so.

"Certainly an attitude can affect one’s immune system," he asserts. Indeed, there is evidence that depression can alter the endocrine and immunological states of not just seniors, but of younger persons as well."