THE NETHERLANDS: Is Depression in Old Age Fatal Only When People Feel Lonely?

Researchers of the Leiden University Medical Center in The Netherlands have found that old persons who suffered from both depression and feelings of loneliness had 2.1 times higher mortality risks, says a report in the American Journal of Psychiatry. METHOD The Leiden 85-Plus Study is a prospective population-based study of the oldest old, with characteristics representative of the 85-year old Dutch population. The study was described in detail elsewhere. In short, since 1997, all members of the 1912-1914 birth cohort living in Leiden were enrolled in the month of their 85th birthday. No a priori selection criteria on Health, congnitive functioning, or living situation were applied. Annually, medical staff and research nurses conducted structured face-to-face interviews, and blood samples were collected. The medical ethical committee of Leiden University Medical Center approved the study OBJECTIVE: The impact of depression and perceived loneliness in the oldest old is largely unknown. The authors studied the relationship between the presence of depressive symptoms and all-cause mortality in old age, especially the potential distorting effect of perceived loneliness. METHOD: Within a prospective population-based study of 85-year-olds, the 15-item Geriatric Depression Scale and the Loneliness Scale were annually applied in all 476 participants with a Mini-Mental State Examination score of 18 points or more. RESULTS: Depression was present in 23% and associated with marital state, institutionalization, and perceived loneliness. When depression and perceived loneliness were assessed during follow-up, neither depression nor perceived loneliness had a significant effect on mortality. However, those who suffered from both depression and feelings of loneliness had a 2.1 times higher mortality risk. CONCLUSIONS: The data suggest that the increased mortality risk attributable to depression in the presence of perceived loneliness may result from motivational depletion. Max L. Stek, M.D., Ph.D., David J. Vinkers, M.D., Jacobijn Gussekloo, M.D., Ph.D., Aartjan T.F. Beekman, M.D., Ph.D., Roos C. van der Mast, M.D., Ph.D., and Rudi G.J. Westendorp, M.D., Ph.D. Reported in Amercian Journal of Psychiatry 162:178-180, January 2005 © 2005 American Psychiatric Association