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An Idea Whose Time Has Come: Promoting Health Equity by Preventing the Syndemic of Depression and Medical Comorbidity

Published:October 28, 2020DOI:https://doi.org/10.1016/j.jagp.2020.10.013
      In this issue of the Journal, Ramit Ravona-Springer et al. use a longitudinal design to study the relationship between depressive symptoms and cognitive changes over time among older adults with diabetes.
      • Ravona-Springer R
      • Heymann A
      • Lin HM
      • et al.
      Increase in number of depression symptoms over time is related to worse cognitive outcomes in older adults with type 2 diabetes.
      Increasing depressive symptoms were associated with decline in cognitive scores. The study calls attention to how depression interacts with medical conditions like diabetes to affect brain health, and highlights the need for more emphasis on prevention of depression. Ample clinical and epidemiologic evidence has demonstrated that the risk for depression is higher with increasing levels of medical comorbidity, that depression is associated with the onset of medical illness and vice versa, and that medical illness accompanied by depression is associated with more functional impairment and mortality than when depression is not present.
      • Mezuk B
      • Gallo JJ
      Depression and medical illness in late life: race, resources, and stress.
      Widespread implementation of effective depression prevention would dramatically improve the public's health—by reducing complications and improving quality of life and survival among persons with chronic medical conditions. Evidence-based, cost-effective strategies can prevent clinical depression,
      • Beekman AT
      • Smit F
      • Stek ML
      • et al.
      Preventing depression in high-risk groups.
      ,
      • McDaid D
      • Park AL
      • Wahlbeck K
      The economic case for the prevention of mental illness.
      but remain largely unused because no commonly used strategy identifies who is most at risk, implements scalable prevention, and addresses policy incentives.
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