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

doi:10.1016/j.jamda.2022.12.005

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

J Am Med Dir Assoc. 2023 May;24(5):679-687. doi: 10.1016/j.jamda.2022.12.005. Epub 2022 Dec 31.

Authors

Madia Lozupone¹, Fabio Castellana², Rodolfo Sardone², Giuseppe Berardino³, Anita Mollica³, Roberta Zupo², Giovanni De Pergola², Chiara Griseta², Roberta Stallone⁴, Maddalena La Montagna³, Vittorio Dibello⁵, Davide Seripa⁶, Antonio Daniele⁷, Mario Altamura³, Vincenzo Solfrizzi⁸, Antonello Bellomo³, Francesco Panza⁹

Affiliations

¹ Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy. Electronic address: madia.lozupone@gmail.com.
² Healthy Aging Phenotypes Research Unit-"Salus in Apulia Study"-National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
³ Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy.
⁴ Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy.
⁵ Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
⁶ Hematology and Stem Cell Transplant Unit, "Vito Fazzi" Hospital, Lecce, Italy.
⁷ Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy; Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
⁸ Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy.
⁹ Healthy Aging Phenotypes Research Unit-"Salus in Apulia Study"-National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy. Electronic address: f_panza@hotmail.com.

PMID: 36596468
DOI: 10.1016/j.jamda.2022.12.005

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.

Keywords: Late-onset depression; frailty; interleukin-6; neuroinflammation; population-based; survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Age of Onset
Aged
Cognition
Cognitive Dysfunction*
Depression* / epidemiology
Depression* / psychology
Follow-Up Studies
Humans