Postdisaster depression is linked to increased mortality risk

Takeaway

• Almost one-third of elderly survivors of the 2011 earthquake and tsunami in Japan reported depression more than 3 years after the disaster.
• This depression was associated with an increased risk for all-cause mortality.
• One-quarter reported posttraumatic stress disorder (PTSD) at the same time, but PTSD was not associated with increased mortality risk.

Why this matters

• Long-term follow-up care after disasters, especially among older adults, should include evaluations for postdisaster depression.

Study design

• Prospective data on 2965 individuals (mean age, 73.4 years) from the Japan Gerontological Evaluation Study were identified.
• During a mean follow-up of 3.3 years, the association among depression, PTSD, and all-cause mortality was evaluated among the older survivors of the earthquake and tsunami.
• Funding: NIH; others.

Key results

• Mean follow-up since the 2013 survey was 3.3 years.
• 32.8% reported postdisaster depression, and 25.2% reported PTSD.
• Depression was significantly associated with an elevated risk for mortality: adjusted (a)HR, 2.29 (P<.001).
• However, the association between PTSD and mortality was not statistically significant: aHR, 1.10 (95% CI, 0.73-1.64).
• Vs individuals without depression/PTSD:
  • Risk increased with depression only: HR, 2.24 (95% CI, 1.43-3.49).
  • Risk increased nonsignificantly with comorbid depression and PTSD: HR, 2.54 (95% CI, 1.50-4.27).

Limitations

• Possibility of selection bias.

Coauthored with Chitra Ravi, MPharm