What symptoms of depression predict mortality in community-dwelling elders?

To determine which symptoms of depression are most likely to increase the risk of mortality in a biracial sample of older adults.

Cross-sectional and longitudinal study.

Baseline and mortality follow-up in urban and rural North Carolina.

Four thousand one hundred sixty-two African-American and white elders aged 65 to 105 at baseline (mean age 73).

Sociodemographic and health factors and four subscales of the Center for Epidemiologic Studies Depression Scale (negative affect, positive affect, somatic symptoms, and interpersonal function) were determined at baseline (1986-87). Mortality was assessed over 10 years of follow-up (through 1996).

Fifty-one percent of the sample died over the 10-year follow-up. In controlled Cox proportional hazards modeling, those who scored lower on the positive affect scale were significantly more likely to die over the 10-year follow-up (hazard ratio=1.12, 95% confidence interval=1.05-1.18). For those who scored higher on the negative affect scale, the somatic scale, and the interpersonal scale, there was no increased risk for mortality in controlled analyses.

These findings suggest that subjective views of well-being may be more important predictors of mortality in older adults than the classic symptoms of depression, such as negative affect and somatic symptoms.