background  The links between depression and increased mortality risk in older persons may depend on the severity of the depressive disorder and on gender.
aim  To investigate the links between severe and 'mild' depressive syndromes and excess mortality in elderly men and women, living in their own homes.
method  Depression (GMS-AGECAT) was assessed in 4051 older persons. After a period of six years we checked the official death registers to find out how many of theses persons had died. The mortality risk for neurotic and psychotic depression was calculated after adjustment for demographic variables, physical illness, cognitive decline and functional disabilities.
results  At the six-year follow-up 75% of the men and 41% of the women with psychotic (severe) depression were found to have died. In both men and women psychotic depression was associated with significantly higher-than-normal mortality. Neurotic (mild) depression was associated with a 1.67-fold higher mortality risk in men only.
conclusions  In the elderly, severe depressive syndromes increase the risk of death in both men and women, whereas mild depression increases the risk of death only in men.