Preventing late-life depression: worth the cost

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"Late-life” depression affects as many as 16 percent of older folks, harms quality of life, increases the risk of death and costs society a bundle each year. A new study shows that preventing the onset of depression during the golden years is not only possible but worth the cost.

From a public health perspective, preventing late-life depression may be “an attractive, if not imperative, means to generate health gains and reduce future costs,” researchers from the Netherlands Institute of Mental Health and Addiction in Utrecht write. As part of the Amsterdam Longitudinal Aging Study, Dr. Filip Smit and colleagues conducted interviews with 2200 adults, 55 to 85 years of age. Of these, 1925 (roughly 87 percent) were free of depression at baseline. After 3 years, 158—about 8 percent—developed depression.

The team calculates that one in every five cases of clinically relevant late-life depression is a new case. “Consequently, depression prevention has to play a key role in reducing the influx of new cases reports,” they write in the Archives of General Psychiatry.

This is best accomplished, the investigators say, by targeting depression prevention efforts to those elderly people most at risk for becoming depressed, which, according to the current study, include being female, having a low level of education, having a small social network, and the presence of two or more chronic illnesses. Those with functional limitations or an “above average” number of depressive symptoms in previous episodes also had an increase risk.

Using this risk profile, roughly 83 percent of future cases of depression can be predicted, Smit’s group notes.

Moreover, if a late-life depression prevention program is even 30 percent successful in avoiding new cases, 1785 new cases of depression will be avoided. This represents a “substantial health gain in a source population of 1 million,” Smit and colleagues point out. Preventing these 1785 new cases of depression could save nearly 2 million dollars for every 1 million elderly Americans.

SOURCE: Archives of General Psychiatry, March 2006.

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