LETTER
Depression, Smoking, and Health Status
Stephen J. Jay, MD
15 December 1997 | Volume 127 Issue 12 | Page 1131
TO THE EDITOR:
Covinsky and colleagues [1] investigated the relation between symptoms of depression and health status outcomes in hospitalized older patients. They found that symptoms of depression were associated with worse health status on admission, discharge, and follow-up. These associations persisted after adjustment for potential confounding factors, including demographic factors, comorbid conditions, and severity of illness. The authors concluded that the poor functional outcomes seen in patients with more symptoms of depression were not caused by worse health status on admission or more severe physiologic illness but by some "probably complex and reciprocal" relation between symptoms of depression and declining health status.
One limitation of this study is the lack of control for smoking status. Among persons 65 years of age or older, the smoking rate has been reported as 12.9% among women and 21.2% among men [2]. Smoking is a major risk factor for 7 of the 14 leading causes of death among persons 60 years of age and older and is a complicating factor for 3 others [3]. Thirty percent to 50% of smokers may have a history of depression [4]. Thus, smoking is not uncommon in the elderly and is associated with both depression and numerous adverse health effects, including illness, death, reduced health care utilization, reduced physical activity, and altered metabolism of medications [5].
The relation between symptoms of depression and health status on admission, discharge, and thereafter may have been confounded by the patients' smoking status on admission. In addition, the smoking cessation or nicotine withdrawal that would have occurred among the hospitalized patients in this study may elicit or exacerbate symptoms of depression in patients with a history of affective disorder [4].
Future studies of the relation between depression and health status outcomes in older persons should control for the potential confounding effects of smoking.
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Author and Article Information
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Indiana University School of Medicine; Indianapolis, IN 46202-5114
1. Covinsky KE, Fortinsky RH, Palmer RM, Kresevic DM, Landefeld CS. Relation between symptoms of depression and health status outcomes in acutely ill hospitalized older persons. Ann Intern Med. 1997; 126:417-25.
2. LaCroix AZ, Lang J, Scherr P, Wallace RB, Cornoni-Huntly J, Berkman L, et al. Smoking and mortality among older men and women in three communities. N Engl J Med. 1991; 324:1619-25.
3. The health benefits of smoking cessation: a report of the Surgeon General. DHHS publication no. 90-8416. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Centers for Chronic Disease Prevention and Health Promotion, Office on smoking and Health; 1990.
4. Fiore MC, Bailey WC, Cohen SJ, et al. Smoking Cessation: Clinical Practice Guideline No. 18 Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1996.
5. Rimer BK, Orleans CT. Older smokers. In: Orleans CT, Slade J, eds. Nicotine Addiction: Principles and Management. New York: Oxford Univ Pr; 1993; 339-49.
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