Fatalism, Optimism, Spirituality, Depressive Symptoms, and Stroke Outcome

Background and Purpose— We sought to describe the association of spirituality, optimism, fatalism, and depressive symptoms with initial stroke severity, stroke recurrence, and poststroke mortality. Methods— Stroke cases from June 2004 to December 2008 were ascertained in Nueces County, TX. Patients without aphasia were queried on their recall of depressive symptoms, fatalism, optimism, and nonorganizational spirituality before stroke using validated scales. The association between scales and stroke outcomes was studied using multiple linear regression with log-transformed National Institutes of Health Stroke Scale and Cox proportional hazards regression for recurrence and mortality. Results— Six hundred sixty-nine patients participated; 48.7% were women. In fully adjusted models, an increase in fatalism from the first to third quartile was associated with all-cause mortality (hazard ratio, 1.41; 95% CI, 1.06–1.88) and marginally associated with risk of recurrence (hazard ratio, 1.35; 95% CI, 0.97–1.88), but not stroke severity. Similarly, an increase in depressive symptoms was associated with increased mortality (hazard ratio, 1.32; 95% CI, 1.02–1.72), marginally associated with stroke recurrence (HR, 1.22; 95% CI, 0.93–1.62), and with a 9.0% increase in stroke severity (95% CI, 0.01–18.0). Depressive symptoms altered the fatalism–mortality association such that the association of fatalism and mortality was more pronounced for patients reporting no depressive symptoms. Neither spirituality nor optimism conferred a significant effect on stroke severity, recurrence, or mortality. Conclusions— Among patients who have already had a stroke, self-described prestroke depressive symptoms and fatalism, but not optimism or spirituality, are associated with increased risk of stroke recurrence and mortality. Unconventional risk factors may explain some of the variability in stroke outcomes observed in populations and may be novel targets for intervention.

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Relationship of Erythrocyte Transfusion with Short- and Long-term Mortality in a Population-based Surgical Cohort

Anesthesiology ◽

10.1097/aln.0b013e318271604e ◽

2012 ◽

Vol 117 (6) ◽

pp. 1175-1183 ◽

Cited By ~ 21

Author(s):

Keyvan Karkouti ◽

Thérèse A. Stukel ◽

W. Scott Beattie ◽

Susie Elsaadany ◽

Ping Li ◽

...

Keyword(s):

Proportional Hazards ◽

Postoperative Mortality ◽

Population Based ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Administrative Databases ◽

Erythrocyte Transfusion ◽

Mortality Hazard ◽

Adjusted Association ◽

Mortality Hazard Ratio

Background When comparing transfused versus nontransfused patients, erythrocyte transfusion is consistently associated with increased mortality. Nonetheless, unmeasured confounding may unduly influence this comparison. This unmeasured risk may have less influence on comparisons of patients undergoing surgery at hospitals with differing transfusion rates. Methods Administrative databases were used to conduct a population-based cohort study of patients who underwent elective hip- or knee-replacement surgery from 1999 to 2008 in Ontario, Canada. The authors used Cox proportional-hazards models to determine the adjusted association of hospital-specific erythrocyte transfusion rates (i.e., comparing hospitals with differing transfusion rates) with postoperative mortality. For comparison, they also determined the adjusted association of patient receipt of transfusion (i.e., comparing transfused vs. nontransfused patients) with mortality. Results Of 162,190 patients, 23% (n=37,015) were transfused. Hospital-specific transfusion rates at the 66 included hospitals ranged from 10.3 to 57.9%. Compared with nontransfused patients, transfused patients experienced increased adjusted 30-day (hazard ratio 2.32; 95% CI, 1.91-2.83) and 1-yr mortality (hazard ratio 1.75; 95% CI, 1.60-1.91). However, when hospitals were categorized into quartiles based on hospital-specific transfusion rates, mortality rates were similar (highest transfusion quartile vs. lowest transfusion quartile: 30-day mortality, hazard ratio 1.11, 95% CI 0.82-1.50; 1-yr mortality, hazard ratio 1.02, 95% CI 0.82-1.26). Conclusions The association of transfusion with postoperative mortality differed significantly when comparing transfused versus nontransfused patients, as opposed to comparing hospitals with differing transfusion rates. This discrepancy raises questions about the true relationship between transfusion and mortality.

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Factors that contribute to urban–rural gradients in risk of schizophrenia: Comparing Danish and Western Australian registers

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211009615 ◽

2021 ◽

pp. 000486742110096

Author(s):

Oleguer Plana-Ripoll ◽

Patsy Di Prinzio ◽

John J McGrath ◽

Preben B Mortensen ◽

Vera A Morgan

Keyword(s):

Confidence Interval ◽

Western Australia ◽

Urban Areas ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Indigenous Status ◽

Increased Risk ◽

The Relationship ◽

Western Australian

Introduction: An association between schizophrenia and urbanicity has long been observed, with studies in many countries, including several from Denmark, reporting that individuals born/raised in densely populated urban settings have an increased risk of developing schizophrenia compared to those born/raised in rural settings. However, these findings have not been replicated in all studies. In particular, a Western Australian study showed a gradient in the opposite direction which disappeared after adjustment for covariates. Given the different findings for Denmark and Western Australia, our aim was to investigate the relationship between schizophrenia and urbanicity in these two regions to determine which factors may be influencing the relationship. Methods: We used population-based cohorts of children born alive between 1980 and 2001 in Western Australia ( N = 428,784) and Denmark ( N = 1,357,874). Children were categorised according to the level of urbanicity of their mother’s residence at time of birth and followed-up through to 30 June 2015. Linkage to State-based registers provided information on schizophrenia diagnosis and a range of covariates. Rates of being diagnosed with schizophrenia for each category of urbanicity were estimated using Cox proportional hazards models adjusted for covariates. Results: During follow-up, 1618 (0.4%) children in Western Australia and 11,875 (0.9%) children in Denmark were diagnosed with schizophrenia. In Western Australia, those born in the most remote areas did not experience lower rates of schizophrenia than those born in the most urban areas (hazard ratio = 1.02 [95% confidence interval: 0.81, 1.29]), unlike their Danish counterparts (hazard ratio = 0.62 [95% confidence interval: 0.58, 0.66]). However, when the Western Australian cohort was restricted to children of non-Aboriginal Indigenous status, results were consistent with Danish findings (hazard ratio = 0.46 [95% confidence interval: 0.29, 0.72]). Discussion: Our study highlights the potential for disadvantaged subgroups to mask the contribution of urban-related risk factors to risk of schizophrenia and the importance of stratified analysis in such cases.

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Abstract MP60: Depressive Symptoms and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.mp60 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Parveen K Garg ◽

Wesley T O'Neal ◽

Ana V Diez Roux ◽

Alvaro Alonso ◽

Elsayed Soliman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Depressive Symptoms ◽

Proportional Hazards ◽

Depression Scale ◽

Epidemiologic Studies ◽

Cox Proportional Hazards ◽

Fee For Service ◽

Score Distribution ◽

Ethnic Study ◽

Increased Risk

Background: Depression has been suggested as a potential risk factor for atrial fibrillation (AF) through effects on the autonomic nervous system and hypothalamus-pituitary-adrenal axis. Current literature examining the prospective relationship between depression and AF is inconsistent and limited to studies performed in predominantly white populations. We determined the relationship of both depressive symptoms and anti-depressant use with incident AF in a multi-ethnic cohort. Methods: The Multi-Ethnic Study of Atherosclerosis is a prospective study of 6,814 individuals without clinical cardiovascular disease. Depressive symptoms were assessed at baseline by the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and use of anti-depressant medications. Five CES-D groups were created based on the score distribution in approximate quartiles, and the top quartile split in 2 such that the top group represented persons with a score ≥16, a value commonly used to identify clinically relevant symptoms. Incident AF was identified from study ECGs verified for AF, ICD-9 hospital discharge diagnoses consistent with AF, and, for participants enrolled in fee-for-service Medicare, inpatient and outpatient AF claims data. Results: 6,644 participants (mean age=62; 53% women; 38% white; 28% black; 22% Hispanic; 12% Chinese-American) were included and followed for a median of 13 years. In separate adjusted Cox proportional hazards analyses, a CES-D≥16 (referent=CES-D<2) and anti-depressant use were each associated with higher incidence of AF (Table). Associations did not differ by race or gender (interaction p-values of 0.18 and 0.17 respectively). Similar results were obtained using time-updated measures of depression. Conclusions: Depressive symptoms are associated with an increased risk of incident AF. Further study into whether improving depressive symptoms reduces AF incidence is important.

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Pain in Patients With Type 2 Diabetes-Related Polyneuropathy Is Associated With Vascular Events and Mortality

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa394 ◽

2020 ◽

Vol 105 (9) ◽

pp. 3005-3014

Author(s):

Brittany R Lapin ◽

Kevin M Pantalone ◽

Alex Milinovich ◽

Shannon Morrison ◽

Andrew Schuster ◽

...

Keyword(s):

Type 2 Diabetes ◽

Proportional Hazards ◽

Negative Binomial ◽

Cox Proportional Hazards ◽

Vascular Events ◽

Proportional Hazards Regression ◽

Increased Risk ◽

History Of ◽

Mortality Hazard Ratio

Abstract Purpose Type 2 diabetes–related polyneuropathy (DPN) is associated with increased vascular events and mortality, but determinants and outcomes of pain in DPN are poorly understood. We sought to examine the effect of neuropathic pain on vascular events and mortality in patients without DPN, DPN with pain (DPN + P), and DPN without pain (DPN-P). Methods A retrospective cohort study was conducted within a large health system of adult patients with type 2 diabetes from January 1, 2009 through December 31, 2016. Using an electronic algorithm, patients were classified as no DPN, DPN + P, or DPN-P. Primary outcomes included number of vascular events and time to mortality. Independent associations with DPN + P were evaluated using multivariable negative binomial and Cox proportional hazards regression models, adjusting for demographics, socioeconomic characteristics, and comorbidities. Results Of 43 945 patients with type 2 diabetes (age 64.6 ± 14.0 years; 52.1% female), 13 910 (31.7%) had DPN: 9104 DPN + P (65.4%) vs 4806 DPN-P (34.6%). Vascular events occurred in 4538 (15.1%) of no DPN patients, 2401 (26.4%) DPN + P, and 1006 (20.9%) DPN-P. After adjustment, DPN + P remained a significant predictor of number of vascular events (incidence rate ratio [IRR] = 1.55, 95% CI, 1.29-1.85), whereas no DPN was protective (IRR = 0.70, 95% CI, 0.60-0.82), as compared to DPN-P. Compared to DPN-P, DPN + P was also a significant predictor of mortality (hazard ratio = 1.42, 95% CI, 1.25-1.61). Conclusions Our study found a significant association between pain in DPN and an increased risk of vascular events and mortality. This observation warrants longitudinal study of the risk factors and natural history of pain in DPN.

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Chronic diarrhoea and risk of rheumatoid arthritis: findings from the French E3N-EPIC Cohort Study

Rheumatology ◽

10.1093/rheumatology/keaa133 ◽

2020 ◽

Vol 59 (12) ◽

pp. 3767-3775 ◽

Cited By ~ 2

Author(s):

Yann Nguyen ◽

Xavier Mariette ◽

Carine Salliot ◽

Gaëlle Gusto ◽

Marie-Christine Boutron-Ruault ◽

...

Keyword(s):

Proportional Hazards ◽

Dietary Habits ◽

Early Stage ◽

Gastrointestinal Disorder ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Gastrointestinal Disorders ◽

Chronic Diarrhoea ◽

Increased Risk ◽

Nutrition Study

Abstract Objectives To assess the relationship between gastrointestinal disorders and the risk of further development of RA. Methods The Etude Epidémiologique auprès des femmes de la Mutuelle générale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition Study is a French prospective cohort including 98 995 healthy women since 1990. Participants completed mailed questionnaires on their lifestyles and health-related information. Gastrointestinal disorders were assessed in the third questionnaire (sent in 1993). Hazard ratios and 95% CIs for incident RA were estimated using Cox proportional hazards regression models with age as the time scale. Models were age adjusted, and then additionally adjusted for known risk factors of RA such as smoking, and for potential cofounders. Results Among 65 424 women, 530 validated incident RA cases were diagnosed after a mean (s.d.) of 11.7 (5.9) years after study baseline. In comparison with no gastrointestinal disorder, chronic diarrhoea was associated with an increased risk of developing RA during follow-up (hazard ratio = 1.70, 95% CI 1.13, 2.58), independently of dysthyroidism or dietary habits. The association was stronger among ever-smokers (hazard ratio = 2.21, 95% CI 1.32, 3.70). There was no association between RA risk and constipation or alternating diarrhoea/constipation. Conclusion Chronic diarrhoea was associated with an increased risk of subsequent RA development, particularly among ever-smokers. These data fit with the mucosal origin hypothesis of RA, where interaction between intestinal dysbiosis and smoking could occur at an early stage to promote emergence of autoimmunity, followed years later by clinical disease.

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Electrocardiographic ST-T Abnormities Are Associated With Stroke Risk in the REGARDS Study

Stroke ◽

10.1161/strokeaha.119.028069 ◽

2020 ◽

Vol 51 (4) ◽

pp. 1100-1106

Author(s):

Mitsuaki Sawano ◽

Ya Yuan ◽

Shun Kohsaka ◽

Taku Inohara ◽

Takeki Suzuki ◽

...

Keyword(s):

Ischemic Stroke ◽

Racial Differences ◽

Stroke Risk ◽

Proportional Hazards ◽

The United States ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Common Finding ◽

Increased Risk

Background and Purpose— In previous studies, isolated nonspecific ST-segment and T-wave abnormalities (NSSTTAs), a common finding on ECGs, were associated with greater risk for incident coronary artery disease. Their association with incident stroke remains unclear. Methods— The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a population-based, longitudinal study of 30 239 white and black adults enrolled from 2003 to 2007 in the United States. NSSTTAs were defined from baseline ECG using the standards of Minnesota ECG Classification (Minnesota codes 4-3, 4-4, 5-3, or 5-4). Participants with prior stroke, coronary heart disease, and major and minor ECG abnormalities other than NSSTTAs were excluded from analysis. Multivariable Cox proportional hazards regression was used to examine calculate hazard ratios of incident ischemic stroke by presence of baseline NSSTTAs. Results— Among 14 077 participants, 3111 (22.1%) had NSSTTAs at baseline. With a median of 9.6 years follow-up, 106 (3.4%) with NSSTTAs had ischemic stroke compared with 258 (2.4%) without NSSTTAs. The age-adjusted incidence rates (per 1000 person-years) of stroke were 2.93 in those with NSSTTAs and 2.19 in those without them. Adjusting for baseline age, sex, race, geographic location, and education level, isolated NSSTTAs were associated with a 32% higher risk of ischemic stroke (hazard ratio, 1.32 [95% CI, 1.05–1.67]). With additional adjustment for stroke risk factors, the risk of stroke was increased 27% (hazard ratio, 1.27 [95% CI, 1.00–1.62]) and did not differ by age, race, or sex. Conclusions— Presence of NSSTTAs in persons with an otherwise normal ECG was associated with a 27% increased risk of future ischemic stroke.

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Alcohol Use Disorders and Increased Risk of Adverse Birth Complications and Outcomes: An 11-Year Nationwide Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228515 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8515

Author(s):

Sarah Soyeon Oh ◽

Yongho Jee ◽

Eun-Cheol Park ◽

Young Ju Kim

Keyword(s):

Alcohol Use ◽

Alcohol Dependence ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Alcohol Use Disorders ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Birth Complications ◽

Increased Risk

For women who suffer from Alcohol Use Disorders (AUDs), the use of alcohol before and/or during pregnancy may result in various birth complications, including miscarriage, stillbirth, or preterm delivery. Thus, this study aimed to explore whether Alcohol Use Disorders (AUDs) are associated with increased risk of adverse birth complications and outcomes. A total of 76,799 deliveries between 2003 and 2013 in the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) were analyzed. Women with an AUD diagnosis preceding delivery were identified as individuals with alcohol dependence. A multivariate Cox proportional hazards model was used to estimate the hazard ratio of adverse birth complications and outcomes associated with alcohol dependence. Diagnosis of an AUD was associated with increased risk of adverse birth complications (Hazard Ratio [HR]: 1.15, 95% CI: 1.01–1.31, p = 0.0302). This was especially the case for women whose AUD diagnosis was in the same year as their delivery (HR: 1.53, 95% CI: 1.24–1.88, p < 0.0001). AUDs were associated with increased risk of adverse birth outcomes, especially when prevalent in the same year as a woman’s delivery. Our study confirms that the monitoring of expecting women with a diagnosis of alcohol-related problems may be useful in preventing adverse birth complications.

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Hemorrhage From Arteriovenous Malformations During Pregnancy

Neurosurgery ◽

10.1227/neu.0b013e318256c34b ◽

2012 ◽

Vol 71 (2) ◽

pp. 349-356 ◽

Cited By ~ 59

Author(s):

Bradley A. Gross ◽

Rose Du

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Venous Drainage ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Relative Paucity ◽

Increased Risk ◽

Risk Of Hemorrhage

Abstract BACKGROUND: Previous hemorrhage, deep venous drainage, and deep location are established risk factors for arteriovenous malformation (AVM) hemorrhage. Although pregnancy is an assumed risk factor, there is a relative paucity of data to support this neurosurgical tenet. OBJECTIVE: To elucidate the hemorrhage rate of AVMs during pregnancy. METHODS: We reviewed the records of 54 women with an angiographic diagnosis of an AVM at our institution. Annual hemorrhage rates were calculated as the ratio of the number of bleeds to total number of patient-years of follow-up. Patient-years of follow-up were tallied assuming lesion presence from birth until AVM obliteration. The Cox proportional hazards model for hemorrhage with pregnancy as the time-dependent variable was used to calculate the hazard ratio. RESULTS: Five hemorrhages in 4 patients occurred over 62 pregnancies, yielding a hemorrhage rate of 8.1% per pregnancy or 10.8% per year. Over the remaining 2461.3 patient-years of follow-up, only 28 hemorrhages occurred, yielding an annual hemorrhage rate of 1.1%. The hazard ratio for hemorrhage during pregnancy was 7.91 (P = 2.23 × 10−4), increasing to 18.12 (P = 7.31 × 10−5) when limiting the analysis to patient follow-up up to age 40. CONCLUSION: Because of the increased risk of hemorrhage from AVMs during pregnancy, we recommend intervention in women who desire to bear children, particularly if the AVM has bled. If the AVM is discovered during pregnancy, we recommend early intervention if it has ruptured; if it is unruptured, we recommend comprehensive counseling, weighing risks of intervention against continuation of pregnancy without intervention.

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Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission

Physical Therapy ◽

10.2522/ptj.20140610 ◽

2015 ◽

Vol 95 (12) ◽

pp. 1660-1667 ◽

Cited By ~ 23

Author(s):

A. Williams Andrews ◽

Dongmei Li ◽

Janet K. Freburger

Keyword(s):

Confidence Interval ◽

Acute Care ◽

Hospital Readmission ◽

Proportional Hazards ◽

Cohort Analysis ◽

Hospital Readmissions ◽

Illness Severity ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Increased Risk

Background Little is known about the use of rehabilitation in the acute care setting and its impact on hospital readmissions. Objective The objective of this study was to examine the association between the intensity of rehabilitation services received during the acute care stay for stroke and the risk of 30-day and 90-day hospital readmission. Design A retrospective cohort analysis of all acute care hospitals in Arkansas and Florida was conducted. Methods Patients (N=64,065) who were admitted for an incident stroke in 2009 or 2010 were included. Rehabilitation intensity was categorized as none, low, medium-low, medium-high, or high based on the sum and distribution of physical therapy, occupational therapy, and speech therapy charges within each hospital. Cox proportional hazards regression was used to estimate hazard ratios, controlling for demographic characteristics, illness severity, comorbidities, hospital variables, and state. Results Relative to participants who received the lowest intensity therapy, those who received higher-intensity therapy had a decreased risk of 30-day readmission. The risk was lowest for the highest-intensity group (hazard ratio=0.86; 95% confidence interval=0.79, 0.93). Individuals who received no therapy were at an increased risk of hospital readmission relative to those who received low-intensity therapy (hazard ratio=1.30; 95% confidence interval=1.22, 1.40). The findings were similar, but with smaller effects, for 90-day readmission. Furthermore, patients who received higher-intensity therapy had more comorbidities and greater illness severity relative to those who received lower-intensity therapy. Limitations The results of the study are limited in scope and generalizability. Also, the study may not have adequately accounted for all potentially important covariates. Conclusions Receipt of and intensity of rehabilitation therapy in the acute care of stroke is associated with a decreased risk of hospital readmission.

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Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796015001171 ◽

2016 ◽

Vol 26 (2) ◽

pp. 189-198 ◽

Cited By ~ 6

Author(s):

J. Damián ◽

R. Pastor-Barriuso ◽

E. Valderrama-Gama ◽

J. de Pedro-Cuesta

Keyword(s):

Depressive Symptoms ◽

Nursing Homes ◽

Life Expectancy ◽

Hazard Ratio ◽

Mortality Hazard ◽

All Cause Mortality ◽

Mortality Hazard Ratio ◽

Long Term Mortality

Background.Studies on depression and mortality in nursing homes have shown inconclusive findings, and none has studied the role of detection. We sought to measure the association of depression with long-term all-cause mortality in institutionalised older people and evaluate a potential modification in the association by its detection status.Methods.We selected a stratified cluster sample of 591 residents aged 75 years or older (mean age 84.5 years) living in residential and nursing homes of Madrid, Spain, who were free of severe cognitive impairment at the 1998–1999 baseline interview. Mortality was ascertained until age 105 years or September 2013 (median/maximum follow-up 4.8/15.2 years) through linkage to the Spanish National Death Index. Detected depression was defined at baseline as a physician's diagnosis or antidepressant use, undetected depression as significant depressive symptoms (score of 4 or higher on the ten-item version of the Geriatric Depression Scale) without documented diagnosis or treatment, and no depression as the absence of diagnosis, treatment, and symptoms. Constant and age-dependent hazard ratios for mortality comparing detected and undetected depression with no depression were estimated using Cox models, and absolute years of life gained and lost using Weibull models.Results.The baseline prevalences of detected and undetected depression were 25.9 and 18.8%, respectively. A total of 499 participants died during 3575 person-years of follow-up. In models adjusted for age, sex, type of facility, number of chronic conditions, and functional dependency, overall depression was not associated with long-term all-cause mortality (hazard ratio 0.87, 95% confidence interval (CI): 0.70–1.08). However, compared with no depression, detected depression showed lower mortality (hazard ratio 0.63, 95% CI: 0.46–0.86), while undetected depression registered higher, not statistically significant, mortality (hazard ratio 1.35, 95% CI: 0.98–1.86). The median life expectancy increased by 1.8 years (95% CI: −3.1 to 6.7 years) in residents with detected depression and decreased by 6.3 years (95% CI: 2.6–10.1 years) in those undetected. Results were more marked in women than men and they were robust to the exclusion of antidepressants from the definition of depression and also to the use of a stricter cut-off for the presence of depressive symptoms.Conclusions.The long-term mortality risk associated with depression in nursing homes depends on its detection status, with better prognosis in residents with detected depression and worse in those undetected. The absolute impact of undetected depressive symptoms in terms of life expectancy can be prominent.

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