The association between, depression, anxiety, and mortality in older people across eight low‐ and middle‐income countries: Results from the 10/66 cohort study
Date
2019-09-15Author
Wu, Yu‐Tzu
Huang, Yueqin
Liu, Zhaorui
Alkholy, Rasha
Kralj, Carolina
Jotheeswaran, Amuthavalli T.
Llibre Rodriguez, Juan J.
Prince, Martin J.
Acosta, Daisy
Guerra, Mariella
Jimenez‐Velazquez7, Ivonne Z.
Salas, Aquiles
Prina, A. Matthew
Sosa, Ana Luisa
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Show full item recordAbstract
Objectives: Depression and anxiety are common mental disorders in later life. Few
population‐based studies have investigated their potential impacts on mortality in
low‐ and middle‐income countries (LMICs). The aim of this study is to examine the
associations between depression, anxiety, their comorbidity, and mortality in later life
using a population‐based cohort study across eight LMICs.
Methods: This analysis was based on the 10/66 cohort study including 15 991 people
aged 65 years or above in Cuba, Dominican Republic, Venezuela, Mexico, Peru,
Puerto Rico, China, and India, with an average follow‐up time of 3.9 years. Subthreshold
and clinical levels of depression were determined using EURO‐D and ICD‐10
criteria, and anxiety was based on Geriatric Mental State (GMS)–Automated Geriatric
Examination for Computer Assisted Taxonomy (AGECAT). Cox proportional hazard
modelling was used to estimate how having depression, anxiety, or both was associated
with mortality adjusting for sociodemographic and health factors.
Results: Participants with clinical depression (hazard ratio [HR]: 1.45; 95% CI, 1.24‐
1.70) and subthreshold anxiety (HR: 1.26; 95% CI, 1.15‐1.38) had higher risk of mortality than those without the conditions after adjusting for sociodemographic factors
and health conditions. Comorbidity of depression and anxiety was associated with
a 30% increased risk of mortality but the effect sizes varied across countries (Higgins
I2 = 58.8%), with the strongest association in India (HR: 1.99; 95% CI, 1.21‐3.27).
Conclusions: Depression and anxiety appear to be associated with mortality in older
people living in LMICs. Variation in effect sizes may indicate different barriers to health
service access across countries. Future studies may investigate underlying mechanisms
and identify potential interventions to reduce the impact of common mental disorders.
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