• Stephen E Gilman, Ewa Sucha, Mila Kingsbury, Nicholas J Horton, Jane M Murphy, and Ian Colman.
• Health Behavior Branch, Division of Intramural Population Health Research (Gilman), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Department of Mental Health (Gilman), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Department of Mathematics and Statistics (Sucha), and School of Epidemiology and Public Health (Sucha, Kingsbury), University of Ottawa, Ottawa, Ont.; Department of Mathematics and Statistics (Horton), Amherst College, Amherst, Mass.; Department of Psychiatry (Murphy), Massachusetts General Hospital and Harvard Medical School; Department of Epidemiology (Murphy), Harvard TH Chan School of Public Health, Boston, Mass.; Department of Psychiatry (Murphy), Dalhousie University Faculty of Medicine, Halifax, NS; School of Epidemiology, Public Health & Preventive Medicine (Colman), University of Ottawa, Ottawa, Ont. stephen.gilman@nih.gov.
• CMAJ. 2017 Oct 23; 189 (42): E1304-E1310.

BackgroundMany studies have shown that depression increases mortality risk. We aimed to investigate the duration of time over which depression is associated with increased risk of mortality, secular trends in the association between depression and mortality, and sex differences in the association between depression and mortality.MethodsWe conducted a cohort study of 3410 adults enrolled in 3 representative samples of a county in Atlantic Canada in 1952 (n = 1003), 1970 (n = 1203) or 1992 (n = 1402) (the Stirling County Study). Depression was measured using a diagnostic algorithm based on the presence of depressed mood and associated symptoms, duration of more than 1 month, and substantial impairment. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database.ResultsDepression was associated with a heightened risk of mortality among men during the 3 time periods of the study, with hazard ratios (HRs) of 2.90 (95% confidence interval [CI] 1.69-4.98) between 1952 and 1967, 1.97 (CI 1.34-2.89) between 1968 and 1990, and 1.52 (CI 1.09-2.13) between 1991 and 2011. Elevated risk of mortality was noted among women only between 1990 and 2011 (HR = 1.51; CI = 1.11-2.05).InterpretationThe association between depression and mortality persists over long periods of time and has emerged among women in recent decades, despite contemporaneous improvements in the treatment of depression and reduction of stigma associated with depression. Further research is needed to better understand the mechanisms involved.© 2017 Canadian Medical Association or its licensors.

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