Relationship of depression and mortality in community-residing elderly individuals - mediating role of frailty and quality of life

Sep 30, 2026

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Depression is linked to higher all-cause mortality in older adults, yet the mediating mechanisms of frailty and quality of life (QOL) in this relationship remain unclear. This prospective study evaluates associations between depression and 12-year all-cause mortality among 988 community-dwelling adults (≥65), using validated measures of depression, frailty, and QOL and applying Cox and mediation models to quantify indirect effects.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Lin etal. BMC Geriatrics (2026) 26:16 BMC Geriatrics [https://doi.org/10.1186/s12877-025-06834-4](https://doi.org/10.1186/s12877-025-06834-4) RESEARCH Open Access Relationship of depression and mortality in community-residing elderly individuals: mediating role of frailty and quality of life Cheng-Chieh Lin 1,2,3, Chia-Ing Li 1,3, Chiu-Shong Liu 1,2, Chih-Hsueh Lin 1,2, Shing-Yu Yang4 and Tsai-Chung Li4,5* Abstract Background Depression is linked to a high risk of mortality from any causes in older adults. However, the role of frailty or quality of life (QOL) as a mediator in the relationship of mortality and depression in older populations has yet to be determined. Mediating variable (frailty or QOL) plays a prominent role in exploring the association between depression and all-cause mortality. The objective of this study is to examine the association between depression and all-cause mortality among community-dwelling older adults and determine the extent to which frailty or QOL acts asa mediator in the association of depression with mortality. Methods Data were obtained from a prospective study of the Taichung Community Health Study for Elders (TCHS-E) that analyzed 988 older adults (≥ 65 years) who were recruited in 2009 and study period lasted until 2021. Depression, frailty, and QOL were measured using the Geriatric Depression Scale (GDS), Fried’s five criteria, and the Short Form 36-item health survey (SF-36), respectively. Cox models were employed to evaluate the associations of depression with all-cause mortality. Mediation models were conducted to estimate the proportional impact of frailty and QOL for the relationship of depression to mortality. Results After 12 years of median follow-up, 357 older persons died. After multivariable adjustment, GDS, frailty components, and four SF-36 domains of physical functioning (PF), general perception of health (GH), social functioning (SF), and physical component summary (PCS) were associated with a 12-year mortality from any causes (hazard ratio [HR]: 1. 06, 95% confidence interval [CI]: 1.01–1. 11; 1. 52, 1.36–1. 70; 0 . 99, 0 .98–0. 99, 0 . 99; 0 .98–0. 99, 0 . 99; 0.99–1. 00; 0 . 97, 0 .96–0. 98, respectively) . The frailty components, PF, SF, and PCS were significant mediators, mediating 49.47%, 52 . 02%, 42 . 66%, and 38. 13% of the effect of GDS on mortality. Conclusions Frailty, physical function, and social function significantly mediated the relationship between depression and mortality. Keywords Depression, Quality of life, Frailty, Mortality, Older adults *Correspondence: Tsai-Chung Li[tcli@mail.cmu.edu.tw](tcli@mail.cmu.edu.tw) 1School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan 2Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan 3Department of Medical Research, China Medical University Hospital, Taichung, Taiwan 4Department of Public Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City 406040, Taiwan R. O. C. 5Department of Audiology and Speech-Language Pathology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Common

FAQs

What is the study’s main objective regarding depression and mortality?

To assess the association between depression and all-cause mortality in community-dwelling older adults and to determine how frailty or QOL mediates that relationship.

How were depression, frailty, and quality of life measured in the study?

Depression was measured using the Geriatric Depression Scale (GDS), frailty using Fried’s five criteria, and QOL using the SF-36 health survey.

Which factors were significant mediators between depression and mortality?

Frailty components, physical functioning (PF), social functioning (SF), and physical component summary (PCS) significantly mediated the depression–mortality relationship.

Sep 30, 2026

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