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Depression, Smoking, and Health Status
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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.
Stephen J. Jay, MD
Indiana University School of Medicine; Indianapolis, IN 46202-5114
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
