Which Elders Are Likely to Develop Depression?

Many elderly people are at risk of developing depression, which is associated with increased disability, mortality, and the risk of institutionalization.  Preventive treatment in those at greatest risk would be most beneficial.  But one must be able to identify those most at risk. Following this goal, University of Rochester researchers have just published the results of a study in the American Journal of Psychiatry.

Patients 65 or older who had no depression were enrolled, and received annual follow-up assessments for one to 4 years.  At enrollment attention was paid to factors that are known to increase the risk of developing depression, including disability, social isola­tion, and chronic medical illnesses, although, of course, not all persons with these risk factors will go on to become depressed.  The annual exams included the Structured Clinical Interview for major depression.

Of 617 patients who enrolled, 405 completed the 1-year follow-up evaluation.  Analysis of the data showed that a distinct combination of factors, including minor or vague depressive symptoms, a history of major or minor depression, and functional impairment, identified a group at high risk for incident depression.  The frequency of this particular combination and the response to treatment allowed calculation of a Number-Needed-to-Treat to prevent one new case of major depression;  this was five, i.e. fully effective treatment of 5 individuals with this combination of risk factors would prevent one new case of depression.      

Awareness of the likelihood of a senior developing depression should allow physicians to treat those at greatest risk, in a relatively inexpensive, simple, way; this represents truly efficient medico-economic practice.