ABSTRACT. Context: Clinically relevant late-life depression has aprevalence of 16% and is associated with substantial societalcosts through its disease burden and unfavorable prognosis.From the public health perspective, depression prevention maybe an attractive, if not imperative, means to generate healthgains and reduce future costs.Objective: To target high-risk groups for depression preventionsuch that maximum health gains are generated against the lowestcost.Design: Population-based cohort study over 3 years.Setting: General population in the Netherlands.Participants: Twenty-two hundred community residents aged55 to 85 years. Of these, 1925 were not depressed at baseline.Main Outcome Measure The onset of clinically relevantdepression was measured with the Center for EpidemiologicalStudies Depression Scale. For each of the risk factors (andtheir combinations), we calculated indices of potential healthgain and the effort (costs) required to generate those healthgains.Results: One in every 5 cases of clinically relevant late-lifedepression is a new case. Consequently, depression preventionhas to play a key role in reducing the influx of new cases.This is best done by directing prevention efforts toward elderlypeople who have depressive symptoms, experience functional impairment,and have a small social network, in particular women, as wellas people who have attained only a low educational level orwho suffer from chronic diseases.Conclusions: Directing prevention efforts toward selectedhigh-risk groups could help reduce the incidence of depressionand is likely to be more cost-effective than alternative approaches.This article further shows that we have the methodology at ourdisposal to conduct ante hoc cost-benefit analysis in preventivepsychiatry. This helps set a rational research and developmentagenda before testing the cost-effectiveness of interventionsin time-consuming and expensive trials.
