Late-life depression and mortality: influence of gender and antidepressant use.

Background: Depression may increase the risk of mortality among certain subgroups of older people, but the part played by antidepressants in this association has not been thoroughly explored.

Aims: To identify the characteristics of older populations who are most at risk of dying, as a function of depressive symptoms, gender and antidepressant use.

Method: Adjusted Cox proportional hazards models were used to determine the association between depression and/or antidepressant use and 4-year survival of 7,363 community-dwelling elderly people. Major depressive disorder was evaluated using a standardised psychiatric examination based on DSM-IV criteria and depressive symptoms were assessed using the Center for Epidemiological Studies-Depression scale.

Results: Depressed men using antidepressants had the greatest risk of dying, with increasing depression severity corresponding to a higher hazard risk. Among women, only severe depression in the absence of treatment was significantly associated with mortality.

Conclusions: The association between depression and mortality is gender-dependent and varies according to symptom load and antidepressant use.