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

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

Research output: Contribution to journalArticlepeer-review


Background 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. Methods 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. Results 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]. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)2634-2642
Number of pages9
JournalPsychological Medicine
Issue number6
StatePublished - Apr 12 2023


  • Biobank
  • depression
  • electronic health records
  • major depressive disorder
  • social activity
  • social determinants of health

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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