Is 13.5% a high rate of major depression? Research demonstrates that depression is both prevalent throughout the
life span and costly in terms of individual suffering, negative sequelae, and health care utilization (3). Embedded in
this literature are debates on whether depression is better
conceptualized and measured as a diagnosis or spectrum
of symptoms (53, 54) and whether diagnoses are more validly or reliability assessed by clinical judgment or self-report (55–57). We chose what might be considered the most
conservative approach, using clinical judgment to make a
strict DSM-IV diagnosis. Using similar criteria and procedures, Lyness et al. (30) reported a prevalence of 6.5% in a
representative sample of older primary care patients. The
difference between that rate and the rate of 13.5% in our
sample suggests that depression is twice as common in
elderly home care patients.