OBJECTIVES: Physical symptoms are known to be associated with late life depression both cross-sectionally and over time. We attempted to determine if self-reported shortness of breath (SoB) is associated with depressive symptoms at long-term (3-year) follow-up in a community sample of older (65+) adults. METHODS: A sample of 2926 elderly subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) were evaluated at baseline and at 3-year follow-up. Depressive symptoms were assessed by a modified version of the Center for Epidemiologic Studies-Depression Scale (CES-D) and SoB was assessed by a three-item scale administered at baseline. The analyses were controlled for factors known to be associated with depressive symptoms and SoB. Both bivariate and multivariate analyses were performed. RESULTS: Eighty-three percent of subjects who experienced SoB survived for three years. Within the analysis sample of those participating at follow-up, 36 percent experienced SoB at baseline. In bivariate analyses, SoB, older age, female sex, history of a heart attack, higher body mass index (BMI), depressive symptoms at baseline, cognitive impairment, and functional impairment were associated with follow-up depressive symptoms. When controlled variables were included in a linear regression model, SoB was a significant predictor of depressive symptoms at follow-up (p < 0.0001) as well as baseline depressive symptoms, sex, BMI, and functional status. No two-way interaction terms with SoB were significant. CONCLUSIONS: SoB is a significant predictor of depressive symptoms at 3-year follow-up. Given that SoB is a symptom that is responsive to therapeutic intervention, active intervention to relieve the symptom when identified could reduce the incidence of depressive symptoms.