The importance of social activity to risk of major depression in older adults.

Euijung Ryu,Alexander W Charney,Yanshan Wang,Jyotishman Pathak,Benjamin S Glicksberg,Priya Wickramaratne,Ardesheer Talati,J John Mann,Mark Olfson,Brandon J Coombes,Gregory D Jenkins,Myrna M Weissman,Joanna M Biernacka,Lauren Lepow

doi:10.1017/s0033291721004566

Abstract

Several social determinants of health (SDoH) have been associated with the onset of major depressive disorder (MDD). However, prior studies largely focused on individual SDoH and thus less is known about the relative importance (RI) of SDoH variables, especially in older adults. Given that risk factors for MDD may differ across the lifespan, we aimed to identify the SDoH that was most strongly related to newly diagnosed MDD in a cohort of older adults. We used self-reported health-related survey data from 41 174 older adults (50-89 years, median age = 67 years) who participated in the Mayo Clinic Biobank, and linked ICD codes for MDD in the participants' electronic health records. Participants with a history of clinically documented or self-reported MDD prior to survey completion were excluded from analysis (N = 10 938, 27%). We used Cox proportional hazards models with a gradient boosting machine approach to quantify the RI of 30 pre-selected SDoH variables on the risk of future MDD diagnosis. Following biobank enrollment, 2073 older participants were diagnosed with MDD during the follow-up period (median duration = 6.7 years). The most influential SDoH was perceived level of social activity (RI = 0.17). Lower level of social activity was associated with a higher risk of MDD [hazard ratio = 2.27 (95% CI 2.00-2.50) for highest v. lowest level]. Across a range of SDoH variables, perceived level of social activity is most strongly related to MDD in older adults. Monitoring changes in the level of social activity may help identify older adults at an increased risk of MDD.

Highlights

Major depressive disorder (MDD) is a highly prevalent chronic condition both in the USA and worldwide, and it is estimated that one in six people will develop the disorder during their lifetime (Howard et al, 2019)
After excluding participants who had a prior history of depression identified via either electronic health records (EHR) or self-report, a total of 30 236 patients
Further studies are needed for replication and to assess whether these findings reflect social determinants of health (SDoH) being a consequence of depression or a cause of depression

Summary

Introduction

Major depressive disorder (MDD) is a highly prevalent chronic condition both in the USA and worldwide, and it is estimated that one in six people will develop the disorder during their lifetime (Howard et al, 2019). Health care professionals can provide early, targeted interventions for those at risk for MDD by monitoring their symptoms before they develop MDD and ensuring they receive adequate treatment, which will be critical for reducing the burden of the disease in older adults. This is especially important, as compared to younger and middle-aged adults, older individuals with MDD are less likely to seek psychiatric treatment Across a range of SDoH variables, perceived level of social activity is most strongly related to MDD in older adults.

Objectives

Methods

Conclusion