摘要:Objectives. We evaluated the effect of depression on risk, on the basis of standardized assessment, for developing activities of daily living (ADL) disability. Methods. Depression-related risk on 2-year ADL disability is estimated from 6871 participants in a population–based national sample aged 54–65 years and free of baseline ADL disability. We evaluated the effects of factors amenable to clinical and public health intervention that may explain the relationship between depression and incident disability. Results. The odds of ADL disability were 4.3 times greater for depressed adults than their non-depressed peers (95% confidence interval=3.1, 6.0). Among depressed adults, 18.7% of African Americans, 8.0% of Whites, and 7.8% of His-panics developed disability within 2 years. The attributable population fraction because of depression is 17.3% (95% confidence interval=11%, 24%). Concurrent health factors moderated depression-associated risk. Conclusions. Elevated risk of ADL disability onset because of depression, in a cohort whose medical costs will imminently be covered via Medicare, is attenuated by factors amenable to public health intervention. Prevention and/or public health/policy programs that lead to more accessible and effective mental health and medical care could reduce the development of ADL disability among depressed adults. Disability has large economic and societal costs among older adults. 1 – 3 Medical spending among the elderly is related more strongly to the presence of disability than to remaining life expectancy. 4 , 5 Among pre-retirement adults, limitations in life activities are strong determinants of job loss and the ability to find employment. 6 , 7 Investigations of precursors for disability show depression is a leading cause. 8 – 11 Numerous clinical, community, and epidemiological studies show that depressed adults have a higher frequency of disability than their non-depressed peers. 8 – 18 However, these studies did not use representative national samples, thereby limiting the generalizability of those findings. Furthermore, race-specific estimates of increased risk from depression for future functional loss are scarce. We attempted to answer three questions regarding differences related to depression as a risk factor for developing (incident) disability with a national sample of pre-retirement adults. First, to what extent do people with depression have increased risk for disability onset compared with their non-depressed peers in this pre-retirement cohort? Second, what are the race-specific risks from depression for incident disability? Third, to what extent are depression-related risks for developing disability explained by sociodemographic, health, or economic factors? Because greater burdens of health conditions, 17 , 19 – 22 and fewer economic resources, 19 , 23 – 25 are associated with both depression and disability, these factors may be entangled in observed differences on incident functional limitation. The influence of such factors will be evaluated on the risk attributed to depression for the development of disability in activities of daily living (ADL). Development of ADL disability is a serious concern because such impairment jeopardizes a person’s ability to live independently. We addressed these questions with longitudinal data from the Health and Retirement Study (HRS). Because depression is both a risk factor and a product of disability, we separate out its predictive role by evaluating the impact of depression on the development of ADL disability among adults initially free of ADL task limitations. In contrast to studies that relied on clinical or community samples to evaluate the impact of depression on incident functional limitations, resulting in findings that cannot be generalized to other populations, 26 we used a national probability sample. This largely pre-retirement HRS sample of older Americans (aged 54–65) is of particular interest because of the deleterious consequences from depression on function and health 22 , 26 in a cohort at peak earnings potential whose medical costs will imminently be covered by public insurance via Medicare.