The cost of late-life depression

(This article was first printed in the February 2005 issue of the Harvard Mental Health Letter. For more information or to order, please go to http://www.health.harvard.edu/mental.)

To judge the true social impact of depression in the elderly and the benefits of treatment, it is essential to take account of free care provided by family members and friends. That conclusion comes from the Health and Retirement Study, conducted at the University of Michigan and funded by the National Institute on Aging.

More than 7,000 people age 70 and over who were asked about their feelings in the week before the interview, answered “yes” or “no” to eight questions that revealed typical symptoms of depression, such as “I was sad,” “Everything was an effort,” and “My sleep was restless.”

Then they were asked whether they had problems or needed help with various daily activities — eating, toileting, dressing, bathing, walking, preparing meals, shopping, telephone calls, taking medications, managing money. Finally, they were asked about any regular free help with any of these activities they were getting from a relative or friend.

Even after correction for age, race, gender, and chronic health conditions, more depressive symptoms meant more limitations on daily activity and more need for unpaid care. People with no depressive symptoms received three hours a week of care on average, those with one to three depressive symptoms, about four hours a week, and those with four to eight depressive symptoms, six hours a week.

Assuming an average pay of eight dollars an hour for home care workers, the authors estimate an equivalent cost of $600 per year for a person with one to three depressive symptoms and $1,330 a year for a person with four to eight symptoms. In the country as a whole, the total would be $9 billion per year.

The authors say that policymakers should consider this cost in deciding how to distribute medical resources, and mental health professionals who treat depressed older patients should be aware of their relatives’ burden.

Langa KM, et al. “Extent and Cost of Informal Caregiving for Older Americans with Symptoms of Depression,” American Journal of Psychiatry (May 2004): Vol. 161, No. 5, pp. 857–63.