Public health prevention policy for depression? An investigation of neighborhood-based determinants among NYC older adults

According to the WHO, depression is the leading cause of disability worldwide. Depression, one of the most costly disorders in the US, is particularly costly for older adults because of associated excess disability. Depression affects over 6 million Americans aged 65 years and older, with an expected doubling within the next 25 years. Yet only 10% of older adults receive treatment. Moreover, with few notable exceptions, there is a dearth of research addressing neighborhood-based determinants of depression risk, prevention, and resiliency. In particular, common aging conditions (i.e. vision loss, hearing impairment) have been under-recognized in the public health literature as risk factors related to depression. To bridge this knowledge gap, this paper presents results of an original investigation into neighborhood and health factors associated with depression among a diverse urban population of community-based older residents. Data are from the Brookdale Healthy Indicators Project (HIP), an interview-based survey administered in six languages to a representative sample of 1,870 community-based older adults attending senior centers in all five boroughs in NYC in 2008. Multi-level modeling techniques reveal striking results. The association with depression is highest for adults enduring: visual impairment (p=.000); frequent falling (p=.000); low income (p=.000); little leisure-time physical activity (p=.000); low neighborhood satisfaction (p=.000); trouble hearing (p=.000); arthritis/rheumatoid arthritis (p=.001); and being disabled (p=.005). Evidence-based effective public health prevention strategies targeting these risk factors could contribute to significantly increased public mental health. New cost effective models of community-based care and support, linking public health and aging services, will be discussed.