Nonsuicidal mortality in late-life depression.

While suicide is the most dramatic cause of premature death in depressed older persons, it is a rare event in old age. Most of the excess mortality associated with late-life depression is due to "natural causes," especially cardiovascular illness. In the past much of the premature death related to psychiatric disorders was the result of epidemics in large, overcrowded institutions, and even today institutional factors may account for some excess mortality. A recent prospective study comparing depressed patients with nondepressed controls found that neither the initial level of physical health nor social factors explained the excess mortality, but it suggested that some of the excess is due to physical causes not readily apparent or disabling. The effects of grief, tricyclic antidepressants, chronic dysphoria, smoking and alcohol abuse, and organic brain disease are considered. Evidence suggests a complex interaction between depression and physical illness (particularly cardiovascular disease) that develops throughout life. Pursuant to these findings, some questions for future research are offered.