Predictors of depression among middle-aged and older men and women in Europe: A machine learning approach

Background The high prevalence of depression in a growing aging population represents a critical public health issue. It is unclear how social, health, cognitive, and functional variables rank as risk/protective factors for depression among older adults and whether there are conspicuous differences among men and women. Methods We used random forest analysis (RFA), a machine learning method, to compare 56 risk/protective factors for depression in a large representative sample of European older adults (N = 67,603; ages 45-105y; 56.1% women; 18 countries) from the Survey of Health, Ageing and Retirement in Europe (SHARE Wave 6). Depressive symptoms were assessed using the EURO-D questionnaire: Scores >= 4 indicated depression. Predictors included a broad array of sociodemographic, relational, health, lifestyle, and cognitive variables. Findings Self-rated social isolation and self-rated poor health were the strongest risk factors, accounting for 22.0% (in men) and 22.3% (in women) of variability in depression. Odds ratios (OR) per +1SD in social isolation were 1.99x, 95% CI [1.90,2.08] in men; 1.93x, 95% CI [1.85,2.02] in women. OR for self-rated poor health were 1.93x, 95% CI [1.81,2.05] in men; 1.98x, 95% CI [1.87,2.10] in women. Difficulties in mobility (in both sexes), difficulties in instrumental activities of daily living (in men), and higher self-rated family burden (in women) accounted for an additional but small percentage of variance in depression risk (2.2% in men, 1.5% in women). Interpretation Among 56 predictors, self-perceived social isolation and self-rated poor health were the most salient risk factors for depression in middle-aged and older men and women. Difficulties in instrumental activities of daily living (in men) and increased family burden (in women) appear to differentially influence depression risk across sexes. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd.