General psychiatric or depressive symptoms were not predictive for mortality in a healthy elderly cohort in Southern Brazil

Cerveira, Maria Otilia; Franz, Adelar Pedro; Camozzato, Ana Luiza; Chaves, Márcia Lorena Fagundes

doi:10.1590/S1980-57642009DN20200008

Abstract

General psychiatric symptoms may interfere with the ability of individuals to take care of their health, to get involved with activities and develop social abilities, thereby increasing risk of death.

Objective:

To evaluate general psychiatric symptoms as predictive factors for mortality in a community elderly cohort in Southern Brazil.

Methods:

345 healthy elderly, aged ³60 years, from the catchment area of Hospital de Clinicas de Porto Alegre were followed from 1996. Data for the present study were drawn from the period 1996-2004. General psychiatric symptoms (Self-Reporting Questionnaire - SRQ), depressive symptoms (Montgomery-Asberg depressive rating scale), and Mini Mental State Examination scores at baseline were included in the study. Socio-demographic, medical conditions, and functional capacity were also analyzed. The outcome was vital status at follow-up obtained from family members, hospital records and checked against official death registers.

Results:

Of the 345 baseline individuals, 246 were followed-up. The global mortality rate over the study period was 36.9% (N=90). Those who deceased during the period were older (73.5±7.5), more dependent overall, and more cognitively impaired than the living elderly (univariate analyses). In the logistic regression, only age (OR=0.93; p=0.003) and functional capacity (OR=0.22; p=0.007) remained significant in the final equation.

Conclusion:

Psychiatric symptoms presented no association with mortality in the present sample. Older age and functional incapacity were risk factors for mortality.

Key words:
psychiatric symptoms; depressive symptoms; mortality; elderly cohort; Brazil.

Resumo

Sintomas psiquiátricos gerais podem interferir com a capacidade do indivíduo cuidar de sua saúde, de envolver-se com outras atividades e desenvolver habilidades sociais, aumentando o risco de morte.

Objetivo:

Avaliar se os sintomas psiquiátricos são preditores de mortalidade em uma coorte de idosos de uma comunidade do sul do Brasil.

Métodos:

345 idosos saudáveis, com idade igual ou superior a 60 anos, da área de abrangência de um hospital universitário de uma cidade do sul do Brasil foram acompanhados desde 1996. Os dados desse estudo representam o período de avaliação de 1996 a 2004. Os sintomas psiquiátricos na avaliação inicial foram medidos através do Self-Reporting Questionnaire (SRQ) e da Escala Montgomery-Asberg para sintomas depressivos (MADRS) e as variáveis independentes foram desempenho cognitivo no Mini Exame do Estado Mental (MEEM). Dados sócio-demográficos, questionário sobre condições sociais e de saúde, e capacidade funcional também foram analizados. O desfecho principal foi mortalidade durante o seguimento, obtida através de familiares e registros de óbito.

Resultados:

Dos 345 idosos "baseline", dados foram obtidos de 246 no seguimento. Taxa de mortalidade global no seguimento foi de 36.9% (N=90). Aqueles que faleceram durante o período de avaliação eram mais idosos (73,5±7,5), mais globalmente dependentes e comprometidos do ponto de vista cognitivo do que os idosos que permaneceram vivos (análises univariadas). Na regressão logística, apenas idade (RC=0,93; p=0,003) e capacidade funcional (RC=0,22; p=0,007) mantiveram significância na equação final.

Conclusões:

Sintomas psiquiátricos não mostraram efeito preditor para mortalidade na presente amostra. Maior idade e incapacitação foram fatores de risco para mortalidade.

Palavras-chave:
sintomas psiquiátricos; sintomas depressivos; mortalidade; coorte de idosos; Brasil.

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Full text available only in PDF format.

References

¹
Berr C, Dartigues JF, Alperovitch A. Cognitive performance and three-year mortality in the PAQUID elderly study. Rev Epidemiol Sante Publique 1994;42:277-284.
²
Johansson B, Zarit SH. Early cognitive markers of the incidence of dementia and mortality: a longitudinal population-based study of the oldest old. Int J Geriatr Psychiatry 1997;12:53-59.
³
Small BJ, Backman L. Cognitive correlates of mortality: evidence from a population based sample of very old adults. Psychol Aging 1997;12:309-313.
⁴
Graham JE, Rockwood K, Beattie BL, et al. Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 1997;349:1793-1796.
⁵
Haan MN, Weldon M. The influence of diabetes, hypertension, and stroke on ethnic differences in physical and cognitive functioning in an ethnically diverse older population. Ann Epidemiol 1996; 6:392-398.
⁶
Vanhanen M, Koivisto K, Karjalainen L, et al. Risk for non-insulin-dependent diabetes in the normoglycaemic elderly is associated with impaired cognitive function. Neuroreport 1997;8:1527-1530.
⁷
Zuccala G, Cattel C, Manes-Gravina E, Di Niro MG, Cocchi A, Bernabei R. Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry 1997;63:509-512.
⁸
Mehta KM, Yaffe K, Langa KM, Sands L, Whooley MA, Covinsky KE. Additive Effects of cognitive function and depressive symptoms on mortality in elderly community-living adults. J Gerontol Med Sci 2003;58:461-467.
⁹
Bruce ML, Leaf PJ, Rozal GP, Florio L, Hoff RA. Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area Study. Am J Psychiatry 1994;10. 151:716-721.
¹⁰
Saz P, Dewey ME. Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int J Geriatr Psychiatry 2001;16:622-630.
¹¹
Vogt T, Pope G, Mullooly J, Hollis J. Mental health status as a predictor of morbidity and mortality: a 15-year follow-up of members of a health maintenance organization. Am J Public Health 1994;84:227-231.
¹²
Callahan CM, Wolinsky FD, Stump TE, Nienaber NA, Hui SL, Tierney WM. Mortality, symptoms, and functional impairment in late-life depression. J Gen Int Med 1998;13:746-752.
¹³
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¹⁴
Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
¹⁵
Maia AL, Godinho C, Ferreira ED, et al. Application of the Brazilian version of the CDR scale in samples of dementia patients. Arq Neuropsiquiatr 2006;64:485-489.
¹⁶
Chaves ML, Camozzato A, Godinho C, et al. Validity of the clinical dementia rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord 2007; 21:210-217.
¹⁷
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382-389.
¹⁸
Dratcu L, da Costa Ribeiro L, Calil HM. Depression assessment in Brazil. The first application of the Montgomery-Asberg Depression Rating Scale. Br J Psychiatry 1987; 150:797-800.
¹⁹
Iacoponi E, Mari JJ. Reliability and factor structure of the Portuguese version of self-reporting questionnaire. Int J Soc Psychiatry 1988;35(Supp 3):213-222.
²⁰
Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of São Paulo. Br J Psychiatry 1986;148:23-26.
²¹
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
²²
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.
²³
Katz A, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 1963;185:914-919.
²⁴
Waite L, Grayson D, Jorm AF, et al. Informant-based staging of dementia using the clinical dementia rating. Alzheimer Dis Assoc Disord 1999;13:34-37.
²⁵
Davis PB, White H, Price JL, et al. Retrospective Postmortem Dementia Assessment. Arch Neurol 1991; 48:613-617.
²⁶
Galvin J, Roe C, Xiong C, et al. Validity and reliability of the AD8 informant interview in dementia. Neurology 2006;67: 1942-1948.
²⁷
Panagiotakos DB, Chrysohoou C, Pitsavos C, et al. Risk factors of stroke mortality: a 40-year follow-up of the Corfu cohort from the Seven-Countries Study. Neuroepidemiology 2003;22:332-338.
²⁸
Ostbye T, Steenhuis R, Wolfson C, Walton R, Hill G. Predictors of five-year mortality in older Canadians: the Canadian Study of Health and Aging. J Am Geriatr Soc 1999;47:1249-1254.
²⁹
Kelman HR, Thomas C, Kennedy GJ, Cheng J. Cognitive impairment and mortality in older community residents. Am J Public Health 1994;84:1255-1260.
³⁰
Ben-Ezra M, Shmotkin D. Predictors of mortality in the old old in Israel: the Cross-sectional and Longitudinal Aging Study. J Am Geriatr Soc 2006;54:906-911.
³¹
Menotti A, Kromhout D, Nissinen A, et al. Short-term all-cause mortality and its determinants in elderly male populations in Finland, The Netherlands, and Italy: the FINE Study. Finland, Italy, Netherlands Elderly Study. Prev Med 1996;25:319-326.
³²
Ramos LR Simoes EJ, Albert MS. Dependence in activities of daily living and cognitive impairment strongly predicted mortality in older urban residents in Brazil: a 2-year follow-up. J Am Geriatr Soc 2001;49:1168-1175.

Publication Dates

Publication in this collection
Apr-Jun 2008

History

Received
04 Apr 2008
Accepted
19 May 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Berr C, Dartigues JF, Alperovitch A. Cognitive performance and three-year mortality in the PAQUID elderly study. Rev Epidemiol Sante Publique 1994;42:277-284.

[2] ²
Johansson B, Zarit SH. Early cognitive markers of the incidence of dementia and mortality: a longitudinal population-based study of the oldest old. Int J Geriatr Psychiatry 1997;12:53-59.

[3] ³
Small BJ, Backman L. Cognitive correlates of mortality: evidence from a population based sample of very old adults. Psychol Aging 1997;12:309-313.

[4] ⁴
Graham JE, Rockwood K, Beattie BL, et al. Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 1997;349:1793-1796.

[5] ⁵
Haan MN, Weldon M. The influence of diabetes, hypertension, and stroke on ethnic differences in physical and cognitive functioning in an ethnically diverse older population. Ann Epidemiol 1996; 6:392-398.

[6] ⁶
Vanhanen M, Koivisto K, Karjalainen L, et al. Risk for non-insulin-dependent diabetes in the normoglycaemic elderly is associated with impaired cognitive function. Neuroreport 1997;8:1527-1530.

[7] ⁷
Zuccala G, Cattel C, Manes-Gravina E, Di Niro MG, Cocchi A, Bernabei R. Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry 1997;63:509-512.

[8] ⁸
Mehta KM, Yaffe K, Langa KM, Sands L, Whooley MA, Covinsky KE. Additive Effects of cognitive function and depressive symptoms on mortality in elderly community-living adults. J Gerontol Med Sci 2003;58:461-467.

[9] ⁹
Bruce ML, Leaf PJ, Rozal GP, Florio L, Hoff RA. Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area Study. Am J Psychiatry 1994;10. 151:716-721.

[10] ¹⁰
Saz P, Dewey ME. Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int J Geriatr Psychiatry 2001;16:622-630.

[11] ¹¹
Vogt T, Pope G, Mullooly J, Hollis J. Mental health status as a predictor of morbidity and mortality: a 15-year follow-up of members of a health maintenance organization. Am J Public Health 1994;84:227-231.

[12] ¹²
Callahan CM, Wolinsky FD, Stump TE, Nienaber NA, Hui SL, Tierney WM. Mortality, symptoms, and functional impairment in late-life depression. J Gen Int Med 1998;13:746-752.

[13] ¹³
IBGE. Instituto Brasileiro de Geografia e Estatística. Diretoria de Pesquisas, Censos Demográficos, Brasília; 2001. Available at <http:/www.ibge.gov.br>. Last access January 20th, 2008.

[14] ¹⁴
Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[15] ¹⁵
Maia AL, Godinho C, Ferreira ED, et al. Application of the Brazilian version of the CDR scale in samples of dementia patients. Arq Neuropsiquiatr 2006;64:485-489.

[16] ¹⁶
Chaves ML, Camozzato A, Godinho C, et al. Validity of the clinical dementia rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord 2007; 21:210-217.

[17] ¹⁷
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382-389.

[18] ¹⁸
Dratcu L, da Costa Ribeiro L, Calil HM. Depression assessment in Brazil. The first application of the Montgomery-Asberg Depression Rating Scale. Br J Psychiatry 1987; 150:797-800.

[19] ¹⁹
Iacoponi E, Mari JJ. Reliability and factor structure of the Portuguese version of self-reporting questionnaire. Int J Soc Psychiatry 1988;35(Supp 3):213-222.

[20] ²⁰
Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of São Paulo. Br J Psychiatry 1986;148:23-26.

[21] ²¹
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[22] ²²
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.

[23] ²³
Katz A, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 1963;185:914-919.

[24] ²⁴
Waite L, Grayson D, Jorm AF, et al. Informant-based staging of dementia using the clinical dementia rating. Alzheimer Dis Assoc Disord 1999;13:34-37.

[25] ²⁵
Davis PB, White H, Price JL, et al. Retrospective Postmortem Dementia Assessment. Arch Neurol 1991; 48:613-617.

[26] ²⁶
Galvin J, Roe C, Xiong C, et al. Validity and reliability of the AD8 informant interview in dementia. Neurology 2006;67: 1942-1948.

[27] ²⁷
Panagiotakos DB, Chrysohoou C, Pitsavos C, et al. Risk factors of stroke mortality: a 40-year follow-up of the Corfu cohort from the Seven-Countries Study. Neuroepidemiology 2003;22:332-338.

[28] ²⁸
Ostbye T, Steenhuis R, Wolfson C, Walton R, Hill G. Predictors of five-year mortality in older Canadians: the Canadian Study of Health and Aging. J Am Geriatr Soc 1999;47:1249-1254.

[29] ²⁹
Kelman HR, Thomas C, Kennedy GJ, Cheng J. Cognitive impairment and mortality in older community residents. Am J Public Health 1994;84:1255-1260.

[30] ³⁰
Ben-Ezra M, Shmotkin D. Predictors of mortality in the old old in Israel: the Cross-sectional and Longitudinal Aging Study. J Am Geriatr Soc 2006;54:906-911.

[31] ³¹
Menotti A, Kromhout D, Nissinen A, et al. Short-term all-cause mortality and its determinants in elderly male populations in Finland, The Netherlands, and Italy: the FINE Study. Finland, Italy, Netherlands Elderly Study. Prev Med 1996;25:319-326.

[32] ³²
Ramos LR Simoes EJ, Albert MS. Dependence in activities of daily living and cognitive impairment strongly predicted mortality in older urban residents in Brazil: a 2-year follow-up. J Am Geriatr Soc 2001;49:1168-1175.

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