Late-Onset Depression but not Early-Onset Depression may Increase the Risk of All-Cause Mortality in Older Age: 8-Year Follow-Up of the Salus in Apulia Study

Madia Lozupone*, Fabio Castellana, Rodolfo Sardone, Giuseppe Berardino, Anita Mollica, Roberta Zupo, Giovanni De Pergola, Chiara Griseta, Roberta Stallone, Maddalena La Montagna, Vittorio Dibello, Davide Seripa, Antonio Daniele, Mario Altamura, Vincenzo Solfrizzi, Antonello Bellomo, Francesco Panza

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objectives: Individuals with late-life depression (LLD) may have shorter survival, but there is a lack of findings in population-based settings about health-related outcomes of LLD and its subtypes: early-onset depression (EOD) and late-onset depression (LOD). We aimed to evaluate the risk of all-cause mortality of individuals with LLD and its subtypes in an older population-based cohort. Moreover, we investigated whether inflammatory, cognitive, genetic features and multimorbidity could modify the effect of this association. Design: Longitudinal population-based study with 8-year follow-up. Setting and Participants: We analyzed data on a sample of 1479 participants, all aged >65 years, in the Salus in Apulia Study. Methods: LLD was diagnosed through DSM-IV-TR criteria and LOD and EOD according to the age of onset. Multimorbidity status was defined as the copresence of 2 or more chronic diseases. Results: The overall prevalence of LLD in this older sample from Southern Italy was 10.2%, subdivided into 3.4% EOD and 6.8% LOD. In multivariable Cox models adjusted for age, gender, education, global cognition, apolipoprotein E ε4 allele, physical frailty, interleukin-6, and multimorbidity, LLD showed a greater risk of all-cause mortality. LOD differed from EOD regarding gender, education, cognitive dysfunctions, and diabetes mellitus. There was a significantly increased risk of all-cause mortality for participants with LOD (hazard ratio:1.99; 95% CI 1.33–2.97) in the time of observation between enrollment date and death date (7.31 ± 2.17 months). Conclusions and Implication: In older age, individuals with LOD but not with EOD had a significantly decreased survival, probably related to increased inflammation, multimorbidity, and cognitive impairments.

Original languageEnglish
Pages (from-to)679-687
Number of pages9
JournalJournal of the American Medical Directors Association
Volume24
Issue number5
Early online date31 Dec 2022
DOIs
Publication statusPublished - May 2023

Bibliographical note

Funding Information:
This study was funded by the Italian Ministry of Health with a “ Ricerca Corrente 2019 ” Grant. The work reported in this publication was granted by the Italian Ministry of Health , under the Studies on Aging Network, at Italian Research Hospitals (IRCCS).

Funding Information:
This study was funded by the Italian Ministry of Health with a “Ricerca Corrente 2019” Grant. The work reported in this publication was granted by the Italian Ministry of Health, under the Studies on Aging Network, at Italian Research Hospitals (IRCCS).We thank the MICOL Study group and the “Salus in Apulia” Research Team. This manuscript is the result of the research work on frailty undertaken by the “Research Network on Aging” team, supported by the resources of the Italian Ministry of Health—Research Networks of National Health Institutes. We thank M.V. Pragnell for her precious help as native English language supervisor. We thank the general practitioners of Castellana Grotte for their fundamental role in supporting the recruitment of participants in these studies: Campanella Cecilia Olga Maria, Daddabbo Annamaria, Dell'aera Giosue’ Giustiniano Rosalia Francesca, Guzzoni Iudice Massimo, Lomuscio Savino, Lucarelli Rocco, Mazzarisi Antonio, Palumbo Mariana, Persio Maria Teresa, Pesce Rosa Vincenza, Puzzovivo Gabriella, Romano Pasqua Maria, Sgobba Cinzia, Simeone Francesco, Tartaglia Paola, and Tauro Nicola. The data that support the findings of the present study are available from the corresponding author (FP) upon reasonable request. Author Contributions: Conceptualization, M.L. F.C. F.P. and R.S.; Methodology, M.L. and F.P.; Software, F.C.; Validation, F.P.; Formal Analysis, F.C.; Investigation, A.M. G.B. R.Z. C.G. R.S. and M.LaM; Data Curation, F.C. A.M. G.B.; Writing – Original Draft Preparation, M.L. and F.C.; Writing Review & Editing F.P. G.DP. V.D. A.D. V.S. M.A. A.B. R.S.; Visualization, R.S.; Supervision, F.P.; Project Administration, R.S; Funding Acquisition, R.S.

Publisher Copyright:
© 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine

Keywords

  • frailty
  • interleukin-6
  • Late-onset depression
  • neuroinflammation
  • population-based
  • survival

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