OBJECTIVE: The mechanism underlying the differential effect of depression on morbidity and mortality in men and women remains unknown. This survey was designed to examine gender effects on the relationship between depressive symptoms and cardiac autonomic function among community dwelling elderly. METHODS: Six hundred and six randomly selected community-dwelling elderly men and women > or = 65 years of age were enrolled. Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale. Cardiac autonomic function was evaluated by measuring heart rate variability (HRV) parameters. Frequency-domain indices of HRV were obtained. RESULTS: Among the subjects, 58.4% were male with a mean age of 77.9 years. Stratified analyses by gender revealed a dose-response association between depressive symptoms and lower cardiac vagal control among elderly males (p = 0.003). Male subjects with mild depressive symptoms (depression scores: 5-6) showed prominent cardiac sympathetic predominance compared with the reference group (depression scores: < 5) (p = 0.005). In contrast, these findings did not exist among elderly females. CONCLUSIONS: The association of depressive symptoms with poor cardiac vagal control and sympathetic predominance was more robust among elderly males than females. This finding may help explain gender differences in the association of depression with morbidity and mortality.