Prevention of late-life depression: a framework and prospectus for research

Depression is a leading cause of disease burden, disability, and distress for millions of older adults. Therefore, prevention of late-life depression (LLD) is a research and public health priority. Much of the research on depression prevention has been guided by the central framework of prevention of mental disorders that was developed by the National Academies of Medicine (NAM). This framework features three modes of prevention, centered on the group or people at risk: 1) indicated prevention, which focuses on those who have symptoms but are below the threshold of clinical disease; 2) selective prevention, which focuses on persons at higher risk to develop a disease because of having key risk factors; 3) universal prevention, which focuses on the population as a whole, regardless of risk factors or risk status. This perspective will provide illustrative examples of all three NAM modes of prevention, including one example from the author's work that simultaneously addressed indicated, selective, and universal prevention of late-life depression in the VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention (VITAL-DEP) study. This paper will also discuss next steps in research to advance LLD prevention, with a view toward ensuring that all older adults can benefit from the increasing range of prevention options available.