Previous studies have shown that depression has a significant impact on all-cause mortality, particularly in men. However, the link between depression and mortality across different age and gender groups is inconsistent. This study aims to explore the relationship between depression and all-cause mortality in various age and gender categories within a Spanish national cohort, while also accounting for other influencing factors over an 11-year follow-up period.
Methods:
A nationally representative sample of the Spanish adult population (n = 4,582) was followed up for 11 years. Kaplan-Meier estimates, unadjusted and adjusted Cox proportional hazard regression models were conducted to test whether baseline depression and sociodemographic characteristics (educational level, low income, marital status, feelings of loneliness, alcohol and tobacco use, and having chronic conditions) were associated with all-cause mortality for different gender and age-specific groups, separately.
Results:
Unadjusted analysis by age and gender indicated that depression had a significant relationship with all-cause mortality in young-and-middle-aged women (HR = 1.75; p < .01) and men (18–64 years old; HR = 2.96; p < .001) and old men (+65; HR = 1.92; p < .001). Adjusted analysis by age and gender revealed that depression was only a significant factor for all-cause mortality in men aged 65+ (HR = 1.60; p = .025).
Limitations:
Cause-specific mortality was not examined. Young adults and middle-aged participants were not analyzed separately.
Conclusions:
The depression and all-cause mortality relationship was found only in +65 men. These differences may be driven by gender-specific factors such as delayed help-seeking, higher levels of social isolation, and the accumulation of chronic comorbidities. Therefore, preventive interventions must prioritize age- and gender-specific strategies to address these risk patterns.
AlmeidaO. P.HankeyG. J.YeapB. B.GolledgeJ.NormanP. E.FlickerL. (2015). Depression, frailty, and all-cause mortality: A cohort study of men older than 75 years. Journal of the American Medical Directors Association, 16(4), 296–300. https://doi.org/10.1016/j.jamda.2014.10.023
2.
AlotaibiR.HalbesmaN.WildS. H.JacksonC. A. (2024). Severe depression and all-cause and cause-specific mortality in Scotland: 20 year national cohort study. BJPsych Open, 10(1), e28. https://doi.org/10.1192/bjo.2023.633
3.
AtlantisE.ShiZ.PenninxB. J. W. H.WittertG. A.TaylorA.AlmeidaO. P. (2012). Chronic medical conditions mediate the association between depression and cardiovascular disease mortality. Social Psychiatry and Psychiatric Epidemiology, 47(4), 615–625. https://doi.org/10.1007/s00127-011-0365-9
4.
BottomleyC.NazarethI.Torres-GonzálezF.ŠvabI.MaaroosH.-I.GeerlingsM. I.XavierM.SaldiviaS.KingM. (2010). Comparison of risk factors for the onset and maintenance of depression. British Journal of Psychiatry, 196(1), 13–17. https://doi.org/10.1192/bjp.bp.109.067116
5.
CabelloM.BorgesG.LaraE.OlayaB.Martín-MariaN.Moreno-AgostinoD.MiretM.CaballeroF. F.HaroJ. M.Ayuso-MateosJ. L. (2020). The relationship between all-cause mortality and depression in different sex and age groups of the Spanish population. Journal of Affective Disorders, 266, 424–428. https://doi.org/10.1016/j.jad.2020.01.162
6.
CuijpersP.VogelzangsN.TwiskJ.KleiboerA.LiJ.PenninxB. W. (2014). Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. American Journal of Psychiatry, 171(4), 453–462. https://doi.org/10.1176/appi.ajp.2013.13030325
7.
DelaneyR. K.TurianoN. A.StroughJ. (2018). Living longer with help from others: Seeking advice lowers mortality risk. Journal of Health Psychology, 23(12), 1590–1597. https://doi.org/10.1177/1359105316664133
8.
FordJ.SpallekM.DobsonA. (2008). Self-rated health and a healthy lifestyle are the most important predictors of survival in elderly women. Age and Ageing, 37(2), 194–200. https://doi.org/10.1093/ageing/afm171
9.
GarinN.KoyanagiA.ChatterjiS.TyrovolasS.OlayaB.LeonardiM.LaraE.KoskinenS.Tobiasz-AdamczykB.Ayuso-MateosJ. L.HaroJ. M. (2016). Global multimorbidity patterns: A cross-sectional, population-based, multi-country study. The Journals of Gerontology: Series A, 71(2), 205–214. https://doi.org/10.1093/gerona/glv128
10.
HughesM. E.WaiteL. J.HawkleyL. C.CacioppoJ. T. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging, 26(6), 655–672. https://doi.org/10.1177/0164027504268574
11.
LaraE.MiretM.OlayaB.CaballeroF. F.MorilloD.MonetaM. V.HaroJ. M.Ayuso-MateosJ. L. (2022). Cohort profile: The Spanish longitudinal study on ageing and health (Edad Con Salud). International Journal of Epidemiology, 51(4), e189–e199. https://doi.org/10.1093/ije/dyac118
12.
LawesS.DemakakosP.SteptoeA.LewisG.CarvalhoL. A. (2019). Combined influence of depressive symptoms and systemic inflammation on all-cause and cardiovascular mortality: Evidence for differential effects by gender in the English Longitudinal Study of Ageing. Psychological Medicine, 49(9), 1521–1531. https://doi.org/10.1017/S003329171800209X
13.
LeonardiM.ChatterjiS.KoskinenS.Ayuso-MateosJ. L.HaroJ. M.FrisoniG.FratturaL.MartinuzziA.Tobiasz-AdamczykB.GmurekM.SerranoR.FinocchiaroC., & Consortium, on behalf of C. in E. P. (2014). Determinants of health and disability in ageing population: The COURAGE in Europe project (Collaborative Research on Ageing in Europe). Clinical Psychology & Psychotherapy, 21(3), 193–198. https://doi.org/10.1002/cpp.1856
14.
LiddonL.KingerleeR.BarryJ. A. (2018). Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking. The British Journal of Clinical Psychology, 57(1), 42–58. https://doi.org/10.1111/bjc.12147
15.
LooperM.de, LafortuneG. (2009). Measuring disparities in health status and in access and use of health care in OECD countries (OECD Health Working Papers, 2009). https://doi.org/10.1787/225748084267
LumleyT. (2004). Analysis of complex survey samples. Journal of Statistical Software, 9(1), 1–19.
18.
Martín-MaríaN.CaballeroF. F.MiretM.TyrovolasS.HaroJ. M.Ayuso-MateosJ. L.ChatterjiS. (2020). Differential impact of transient and chronic loneliness on health status. A longitudinal study. Psychology & Health, 35(2), 177–195. https://doi.org/10.1080/08870446.2019.1632312
19.
MiretM.CaballeroF. F.ChatterjiS.OlayaB.Tobiasz-AdamczykB.KoskinenS.LeonardiM.HaroJ. M.Ayuso-MateosJ. L. (2014). Health and happiness: Cross-sectional household surveys in Finland, Poland, and Spain. Bulletin of the World Health Organization, 92(10), 716–725. https://doi.org/10.2471/BLT.13.129254
20.
MoussaviS.ChatterjiS.VerdesE.TandonA.PatelV.UstunB. (2007). Depression, chronic diseases, and decrements in health: Results from the World Health Surveys. The Lancet, 370(9590), 851–858. https://doi.org/10.1016/S0140-6736(07)61415-9
21.
OlayaB.MonetaM. V.Plana-RipollO.HaroJ. M. (2023). Association between mental disorders and mortality: A register-based cohort study from the region of Catalonia. Psychiatry Research, 320, 115037. https://doi.org/10.1016/j.psychres.2022.115037
22.
ParkS. J.RimS. J.KimC. E.ParkS. (2019). Effect of comorbid depression on health-related quality of life of patients with chronic diseases: A South Korean nationwide study (2007–2015). Journal of Psychosomatic Research, 116, 17–21. https://doi.org/10.1016/j.jpsychores.2018.11.004
23.
PlugI.HoffmannR.ArtnikB.BoppM.BorrellC.CostaG.DeboosereP.EsnaolaS.KaledieneR.LeinsaluM.LundbergO.MartikainenP.RegidorE.RychtarikovaJ.StrandB. H.WojtyniakB.MackenbachJ. P. (2012). Socioeconomic inequalities in mortality from conditions amenable to medical interventions: Do they reflect inequalities in access or quality of health care?BMC Public Health, 12(1), 346. https://doi.org/10.1186/1471-2458-12-346
24.
Posit team. (2023). RStudio: Integrated development environment for R [Computer software]. https://www.posit.co/
25.
RajanS.McKeeM.RangarajanS.BangdiwalaS.RosengrenA.GuptaR.KuttyV. R.WielgoszA.LearS.AlHabibK. F.CoH. U.Lopez-JaramilloP.AvezumA.SeronP.OguzA.KrugerI. M.DiazR.NafizaM.-N.ChifambaJ., . . . Prospective Urban Rural Epidemiology (PURE) Study Investigators. (2020). Association of symptoms of depression with cardiovascular disease and mortality in low-, middle-, and high-income countries. JAMA Psychiatry, 77(10), 1052–1063. https://doi.org/10.1001/jamapsychiatry.2020.1351
26.
RappM. A.GerstorfD.HelmchenH.SmithJ. (2008). Depression predicts mortality in the young old, but not in the oldest old: Results from the Berlin Aging Study. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 16(10), 844–852. https://doi.org/10.1097/JGP.0b013e31818254eb
Rico-UribeL. A.CaballeroF. F.Martín-MaríaN.CabelloM.Ayuso-MateosJ. L.MiretM. (2018). Association of loneliness with all-cause mortality: A meta-analysis. PLoS One, 13(1), e0190033. https://doi.org/10.1371/journal.pone.0190033
29.
RodríguezJ. M. J. (2024). La soledad no deseada en España: Un problema para la gestión de la Salud Pública y los cuidados familiares: e202403025. Revista Española de Salud Pública, 98, pp 3.
30.
SimonG. E.GoldbergD. P.KorffM. V.ÜstünT. B. (2002). Understanding cross-national differences in depression prevalence. Psychological Medicine, 32(4), 585–594. https://doi.org/10.1017/S0033291702005457
31.
SjobergD., D.WhitingK.CurryM.LaveryJ., A.LarmarangeJ. (2021). Reproducible Summary Tables with the gtsummary Package. The R Journal, 13(1), 570. https://doi.org/10.32614/RJ-2021-053
WangY.JiaoY.NieJ.O’NeilA.HuangW.ZhangL.HanJ.LiuH.ZhuY.YuC.WoodwardM. (2020). Sex differences in the association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: A systematic review and meta-analysis of 7,881,040 individuals. Global Health Research and Policy, 5(1), 4. https://doi.org/10.1186/s41256-020-00133-8
34.
WickeF. S.ErnstM.OttenD.WernerA.DreierM.BrählerE.TibubosA. N.ReinerI.MichalM.WiltinkJ.MünzelT.LacknerK. J.PfeifferN.KönigJ.WildP. S.BeutelM. E. (2022). The association of depression and all-cause mortality: Explanatory factors and the influence of gender. Journal of Affective Disorders, 303, 315–322. https://doi.org/10.1016/j.jad.2022.02.034
35.
WickhamH.AverickM.BryanJ.ChangW.McGowanL.FrançoisR.GrolemundG.HayesA.HenryL.HesterJ.KuhnM.PedersenT.MillerE.BacheS.MüllerK.OomsJ.RobinsonD.SeidelD.SpinuV., . . . YutaniH. (2019). Welcome to the Tidyverse. Journal of Open Source Software, 4(43), 1686. https://doi.org/10.21105/joss.01686
World Health Organization. (2017). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/
38.
World Health Organization. (2018). Management of physical health conditions in adults with severe mental disorders: WHO guidelines. Author. https://iris.who.int/handle/10665/275718
XuK. Q.AwJ. Y. H.PayneC. F. (2024). Inequalities in mortality in the Asia-Pacific: A cross-national comparison of socioeconomic gradients. The Journals of Gerontology: Series B, 79(4), gbad193. https://doi.org/10.1093/geronb/gbad193
41.
ZivinK.YosefM.MillerE. M.ValensteinM.DuffyS.KalesH. C.VijanS.KimH. M. (2015). Associations between depression and all-cause and cause-specific risk of death: A retrospective cohort study in the Veterans Health Administration. Journal of Psychosomatic Research, 78(4), 324–331. https://doi.org/10.1016/j.jpsychores.2015.01.014
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