Table 1.

Methodologic challenges confronting depression prevention research in older adults

Components of the Mission	What is Needed to Address the Mission	Related Methodologic Challenges
Prevention of episodes of depression	Better understanding of the nature of and interrelationships among risk factors to target when and how to intervene	Identification, modification, validation of efficient (low burden, feasible, strong psychometrics) assessments for multiple domains of factors Development of statistical methods to better characterize complex sets of risk factors and their trajectories over time Development of classification techniques that allow care providers to efficiently gauge risk for depression in their clients
	Wider range of strategies to deliver prevention interventions Appropriate timing/sequencing of interventions	Migration of traditional face-to-face intervention delivery to telemedicine-based formats without loss of fidelity and effectiveness Development/adaptation of research designs and analytic strategies to incorporate multiple durations and sequences of treatments to accommodate care provider/patient preferences
	Accurate identification of change in clinical status	Development of efficient, low cost measures acceptable to patients/providers and sensitive to change
Depression prevention in the community, particularly in underserved, low-income populations	Better engagement/retention of underserved older adults in interventions; facilitation of their response to intervention Engagement of community-based health care and services providers as prevention partners	Determination of whether depression outcome and risk factor assessments are feasible, acceptable, and valid Development/adaptation of research designs and analytic strategies to accommodate patient preferences for preventive care Determination of acceptability of depression and risk factor assessments to community-based assessors/care providers
Sustainability of depression prevention efforts	Strategies to facilitate transportability of prevention interventions into the community for sustained use	Refinement/application of a standardized approach to characterize intervention delivery and content Evaluation of costs and reimbursability of prevention interventions Development of assessments for depression outcomes and risk factors that can be easily used by community-based care providers Development/adaptation of research designs and analytic strategies to accommodate patient/care provider preferences for preventive care
	Training of the next generation of researchers conducting effectiveness and dissemination studies	Dissemination of approaches to increase intervention transportability to new settings, populations, and care providers Dissemination of new assessment tools, research design strategies, and analytic tools for prevention effectiveness trials