The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study

Yu-Tzu Wu; Carolina Kralj; Daisy Acosta; Mariella Guerra; Yueqin Huang; Amuthavalli T Jotheeswaran; Ivonne Z Jimenez-Velazquez; Zhaorui Liu; Juan J Llibre Rodriguez; Aquiles Salas; Ana Luisa Sosa; Rasha Alkholy; Martin Prince; A Matthew Prina

doi:10.1002/gps.5211

The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study

Yu-Tzu Wu, Carolina Kralj, Daisy Acosta, Mariella Guerra, Yueqin Huang, Amuthavalli T Jotheeswaran, Ivonne Z Jimenez-Velazquez, Zhaorui Liu, Juan J Llibre Rodriguez, Aquiles Salas, Ana Luisa Sosa, Rasha Alkholy, Martin Prince, A Matthew Prina

TREAT Service, South London and Maudsley Foundation NHS Trust, Maudsley Hospital, London, SE5 8AZ, UK.
Internal Medicine Department, Geriatric Section, Universidad Nacional Pedro Henriquez Ureña (UNPHU), Santo Domingo, Dominican Republic.
Psychogeriatric Unit, National Institute of Mental Health Honorio Delgado Hideyo Noguchi, Lima, Peru and Centro de la Memoria y Desordenes Relacionados, Lima, Perú.
Peking University, Institute of Mental Health, Beijing, China.
Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.
Internal Medicine Department, Geriatrics Program, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
Facultad de Medicina Finlay-Albarran, Medical University of Havana, Havana, Cuba.
Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela.
National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico.

Research output: Contribution to journal › Article › peer-review

28 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	29-36
Number of pages	8
Journal	International Journal of Geriatric Psychiatry
Volume	35
Issue number	1
DOIs	https://doi.org/10.1002/gps.5211
Publication status	Published - Jan 2020

Keywords

anxiety
common mental disorders
depression
epidemiology
mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/gps.5211

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Wu, Y.-T., Kralj, C., Acosta, D., Guerra, M., Huang, Y., Jotheeswaran, A. T., Jimenez-Velazquez, I. Z., Liu, Z., Llibre Rodriguez, J. J., Salas, A., Sosa, A. L., Alkholy, R., Prince, M., & Prina, A. M. (2020). The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study. International Journal of Geriatric Psychiatry, 35(1), 29-36. https://doi.org/10.1002/gps.5211

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title = "The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study",

abstract = "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.",

keywords = "anxiety, common mental disorders, depression, epidemiology, mortality",

author = "Yu-Tzu Wu and Carolina Kralj and Daisy Acosta and Mariella Guerra and Yueqin Huang and Jotheeswaran, {Amuthavalli T} and Jimenez-Velazquez, {Ivonne Z} and Zhaorui Liu and {Llibre Rodriguez}, {Juan J} and Aquiles Salas and Sosa, {Ana Luisa} and Rasha Alkholy and Martin Prince and Prina, {A Matthew}",

note = "{\textcopyright} 2019 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.",

year = "2020",

month = jan,

doi = "10.1002/gps.5211",

language = "English",

volume = "35",

pages = "29--36",

journal = "International Journal of Geriatric Psychiatry",

issn = "0885-6230",

publisher = "John Wiley and sons",

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Wu, Y-T, Kralj, C, Acosta, D, Guerra, M, Huang, Y, Jotheeswaran, AT, Jimenez-Velazquez, IZ, Liu, Z, Llibre Rodriguez, JJ, Salas, A, Sosa, AL, Alkholy, R, Prince, M & Prina, AM 2020, 'The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study', International Journal of Geriatric Psychiatry, vol. 35, no. 1, pp. 29-36. https://doi.org/10.1002/gps.5211

TY - JOUR

T1 - The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries

T2 - Results from the 10/66 cohort study

AU - Wu, Yu-Tzu

AU - Kralj, Carolina

AU - Acosta, Daisy

AU - Guerra, Mariella

AU - Huang, Yueqin

AU - Jotheeswaran, Amuthavalli T

AU - Jimenez-Velazquez, Ivonne Z

AU - Liu, Zhaorui

AU - Llibre Rodriguez, Juan J

AU - Salas, Aquiles

AU - Sosa, Ana Luisa

AU - Alkholy, Rasha

AU - Prince, Martin

AU - Prina, A Matthew

PY - 2020/1

Y1 - 2020/1

N2 - 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.

AB - 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.

KW - anxiety

KW - common mental disorders

KW - depression

KW - epidemiology

KW - mortality

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U2 - 10.1002/gps.5211

DO - 10.1002/gps.5211

M3 - Article

C2 - 31608478

SN - 0885-6230

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JO - International Journal of Geriatric Psychiatry

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The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study

Abstract

Keywords

UN SDGs

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