Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 10, pp 1243–1253 | Cite as

Depression and alcohol misuse among older adults: exploring mechanisms and policy impacts using agent-based modelling

  • Ivana StankovEmail author
  • Yong Yang
  • Brent A. Langellier
  • Jonathan Purtle
  • Katherine L. Nelson
  • Ana V. Diez Roux
Original Paper



To: (1) explore how multi-level factors impact the longitudinal prevalence of depression and alcohol misuse among urban older adults (≥ 65 years), and (2) simulate the impact of alcohol taxation policies and targeted interventions that increase social connectedness among excessive drinkers, socially isolated and depressed older adults; both alone and in combination.


An agent-based model was developed to explore the temporal co-evolution of depression and alcohol misuse prevalence among older adults nested in a spatial network. The model was based on Los Angeles and calibrated longitudinally using data from the Multi-Ethnic Study of Atherosclerosis.


Interventions with a social component targeting depressed and socially isolated older adults appeared more effective in curbing depression prevalence than those focused on excessive drinkers. Targeting had similar impacts on alcohol misuse, though the effects were marginal compared to those on depression. Alcohol taxation alone had little impact on either depression or alcohol misuse trajectories.


Interventions that improve social connectedness may reduce the prevalence of depression among older adults. Targeting considerations could play an important role in determining the success of such efforts.


Mental health Chronic disease Health policy Complex systems Agent-based model 



Research for and preparation of this manuscript was supported by the European Union Horizon 2020 Framework Programme [Grant Number 667661] (Promoting mental wellbeing in the ageing population—MINDMAP). The study does not necessarily reflect the Commission’s views and in no way anticipates the Commission’s future policy in this area. The MESA study was also supported by the National Heart, Lung, and Blood Institute (Contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169), the National Center for Advancing Translational Sciences (Grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420), the National Heart, Lung, and Blood Institute at the National Institutes of Health (Grants R01 HL071759). We thank the other investigators, staff, and participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at The authors are grateful for discussions and feedback provided by Mr Peter Lekkas.

Author contributions

IS initiated the idea for the research, designed the agent-based model, wrote and executed the code, prepared the graphics output, wrote the first draft of the manuscript, and critically revised subsequent versions of the paper. YY, BAL, JP, KLN, and AVDR contributed to the conceptualization of the model, helped with methodological interpretations, gave critical feedback, and provided revisions to the manuscript.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

127_2019_1701_MOESM1_ESM.pdf (292 kb)
Supplementary material 1 (PDF 291 kb)
127_2019_1701_MOESM2_ESM.pdf (182 kb)
Supplementary material 2 (PDF 182 kb)
127_2019_1701_MOESM3_ESM.pdf (162 kb)
Supplementary material 3 (PDF 162 kb)
127_2019_1701_MOESM4_ESM.pdf (274 kb)
Supplementary material 4 (PDF 274 kb)
127_2019_1701_MOESM5_ESM.pdf (227 kb)
Supplementary material 5 (PDF 226 kb)


  1. 1.
    World Health Organisation (2017) Mental health of older adults: Fact sheet [Press release]. Accessed 14 July 2018
  2. 2.
    United Nations (2014) Population facts: population ageing and sustainable development. United Nations, Department of Economic and Scoial Affairs, Population Division. pp 1–4. Accessed 29 Mar 2018
  3. 3.
    Beekman ATF, Copeland J, Prince MJ (2018) Review of community prevalence of depression in later life. Br J Psychiatry 174(4):307–311CrossRefGoogle Scholar
  4. 4.
    Schulz R et al (2000) Association between depression and mortality in older adults: the cardiovascular health study. Arch Intern Med 160(12):1761–1768CrossRefGoogle Scholar
  5. 5.
    Lenze EJ et al (2001) The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. Am J Geriatr Psychiatry 9(2):113–135CrossRefGoogle Scholar
  6. 6.
    Blazer DG (2003) Depression in late life: review and commentary. J Gerontol Ser A 58(3):M249–M265CrossRefGoogle Scholar
  7. 7.
    Center for Substance Abuse Treatment (1998) Substance abuse among older adults. In: Treatment improvement protocol (TIP) series. Substance Abuse and Mental Health Services Administration, Rockville, p 204. Accessed 18 Apr 2018
  8. 8.
    Gell L, Meier PS, Goyder E (2015) Alcohol consumption among the over 50 s: international comparisons. Alcohol Alcohol 50(1):1–10CrossRefGoogle Scholar
  9. 9.
    Wu LT, Blazer DG (2014) Substance use disorders and psychiatric comorbidity in mid and later life: a review. Int J Epidemiol 43(2):304–317CrossRefGoogle Scholar
  10. 10.
    St John PD, Montgomery PR, Tyas SL (2009) Alcohol misuse, gender and depressive symptoms in community-dwelling seniors. Int J Geriatr Psychiatry 24(4):369–375CrossRefGoogle Scholar
  11. 11.
    Devanand DP (2002) Comorbid psychiatric disorders in late life depression. Biol Psychiatry 52(3):236–242CrossRefGoogle Scholar
  12. 12.
    Brennan PL et al (2015) Alcohol use predicts 10-year depressive symptom trajectories in the Health and Retirement Study. J Aging Health 28(5):911–932CrossRefGoogle Scholar
  13. 13.
    Peirce RS et al (2000) A longitudinal model of social contact, social support, depression, and alcohol use. Health Psychol 19(1):28–38CrossRefGoogle Scholar
  14. 14.
    Hartka E et al (2010) A meta-analysis of depressive symptomatology and alcohol consumption over time. Br J Addict 86(10):1283–1298CrossRefGoogle Scholar
  15. 15.
    Gilman SE, Abraham HD (2001) A longitudinal study of the order of onset of alcohol dependence and major depression. Drug Alcohol Depend 63(3):277–286CrossRefGoogle Scholar
  16. 16.
    Nianogo RA, Arah OA (2015) Agent-based modeling of noncommunicable diseases: a systematic review. Am J Public Health 105(3):e20–e31CrossRefGoogle Scholar
  17. 17.
    Tracy M, Cerdá M, Keyes KM (2018) Agent-based modeling in public health: current applications and future directions. Annu Rev Public Health 39(1):77–94CrossRefGoogle Scholar
  18. 18.
    Langellier BA et al (2019) Complex systems approaches to understand drivers of mental health and inform mental health policy: a systematic review. Adm Policy Ment Health 46(2):128–144CrossRefGoogle Scholar
  19. 19.
    Wagenaar AC, Salois MJ, Komro KA (2009) Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies. Addiction 104(2):179–190CrossRefGoogle Scholar
  20. 20.
    Elder RW et al (2010) The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. Am J Prev Med 38(2):217–229CrossRefGoogle Scholar
  21. 21.
    Xu X, Chaloupka FJ (2011) The effects of prices on alcohol use and its consequences. Alcohol Res Health 34(2):236–245PubMedPubMedCentralGoogle Scholar
  22. 22.
    Cox J (2017) Combatting loneliness one conversation at a time: a call to action. Commission on loneliness, pp 1–21. Accessed 5 Aug 2018
  23. 23.
    Choi H, Irwin MR, Cho HJ (2015) Impact of social isolation on behavioral health in elderly: systematic review. World J Psychiatry 5(4):432–438CrossRefGoogle Scholar
  24. 24.
    Preston P, Goodfellow M (2006) Cohort comparisons: social learning explanations for alcohol use among adolescents and older adults. Addict Behav 31(12):2268–2283CrossRefGoogle Scholar
  25. 25.
    Hammond RA (2015) Appendix A: considerations and best practices in agent-based modeling to inform policy. In: Wallace R, Geller A, Ogawa V (eds) Assessing the use of agent-based models for tobacco regulation. National Academies Press (US): Washington, DCGoogle Scholar
  26. 26.
    Lewinsohn PM et al (1997) Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging 12(2):277–287CrossRefGoogle Scholar
  27. 27.
    Gopalakrishnan V, Kim M, An G (2013) Using an agent-based model to examine the role of dynamic bacterial virulence potential in the pathogenesis of surgical site infection. Adv Wound Care 2(9):510–526CrossRefGoogle Scholar
  28. 28.
    Bild DE et al (2002) Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol 156(9):871–881CrossRefGoogle Scholar
  29. 29.
    Radloff LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401CrossRefGoogle Scholar
  30. 30.
    Wrzus C et al (2013) Social network changes and life events across the life span: a meta-analysis. Psychol Bull 139(1):53–80CrossRefGoogle Scholar
  31. 31.
    Lambiotte R et al (2008) Geographical dispersal of mobile communication networks. Phys A 387(21):5317–5325CrossRefGoogle Scholar
  32. 32.
    Onnela J-P et al (2011) Geographic constraints on social network groups. PLoS One 6(4):e16939CrossRefGoogle Scholar
  33. 33.
    DiLoreto JT et al (2012) Assessment of the average price and ethanol content of alcoholic beverages by brand—United States, 2011. Alcohol Clin Exp Res 36(7):1288–1297CrossRefGoogle Scholar
  34. 34.
    Wilensky U (1999) Center for connected learning and computer-based modeling. Netlogo. Northwestern University, EvanstonGoogle Scholar
  35. 35.
    Hajat S et al (2004) Patterns and determinants of alcohol consumption in people aged 75 years and older: results from the MRC trial of assessment and management of older people in the community. Age Ageing 33(2):170–177CrossRefGoogle Scholar
  36. 36.
    Kharicha K et al (2007) Health risk appraisal in older people 1: are older people living alone an “at-risk” group? Br J Gen Pract 57(537):271–276PubMedPubMedCentralGoogle Scholar
  37. 37.
    Weyerer S et al (2009) At-risk alcohol drinking in primary care patients aged 75 years and older. Int J Geriatr Psychiatry 24(12):1376–1385CrossRefGoogle Scholar
  38. 38.
    Kelly S et al (2018) Alcohol and older people: a systematic review of barriers, facilitators and context of drinking in older people and implications for intervention design. PLoS One 13(1):e0191189CrossRefGoogle Scholar
  39. 39.
    Railsback SF, Grimm V (2012) Agent-based and individual-based modeling: a practical introduction. Princeton University Press, PrincetonGoogle Scholar
  40. 40.
    Brennan PL, Moos RH, Mertens JR (1994) Personal and environmental risk factors as predictors of alcohol use, depression, and treatment-seeking: a longitudinal analysis of late-life problem drinkers. J Subst Abuse 6(2):191–208CrossRefGoogle Scholar
  41. 41.
    World Health Organisation (2004) global status report: alcohol policy. World Health Organisation, GenevaGoogle Scholar
  42. 42.
    Dickens AP et al (2011) Interventions targeting social isolation in older people: a systematic review. BMC Public Health 11(1):647CrossRefGoogle Scholar
  43. 43.
    Martineau F et al (2013) Population-level interventions to reduce alcohol-related harm: an overview of systematic reviews. Prev Med 57(4):278–296CrossRefGoogle Scholar
  44. 44.
    Yang Y (2017) Using agent-based modeling to study multiple risk factors and multiple health outcomes at multiple levels. Ann N Y Acad Sci 1408(1):7–14CrossRefGoogle Scholar
  45. 45.
    Zivin K et al (2013) Trends in depressive symptom burden among older adults in the United States from 1998 to 2008. J Gen Intern Med 28(12):1611–1619CrossRefGoogle Scholar
  46. 46.
    Balzer DG, Wu L-T (2009) The epidemiology of at-risk and binge drinking among middle-aged and elderly community adults: national Survey on Drug Use and Health. Am J Psychiatry 166(10):1162–1169CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ivana Stankov
    • 1
    Email author
  • Yong Yang
    • 2
  • Brent A. Langellier
    • 3
  • Jonathan Purtle
    • 3
  • Katherine L. Nelson
    • 3
  • Ana V. Diez Roux
    • 1
  1. 1.Urban Health Collaborative, Dornsife School of Public HealthDrexel UniversityPhiladelphiaUSA
  2. 2.Division of Social and Behavioral Science, School of Public HealthUniversity of MemphisMemphisUSA
  3. 3.Department of Health Management and Policy, Dornsife School of Public HealthDrexel UniversityPhiladelphiaUSA

Personalised recommendations