Geographic Disparities of Community-level 65+ Depression Prevalence in Five New England States

TL;DR

This study finds that depression rates among people over 65 vary significantly by location in New England, with urban and rural areas showing different patterns.

Contribution

The study identifies geographic disparities in depression prevalence among older adults in five New England states using detailed community-level data.

Findings

Massachusetts had the highest 65+ depression rate (54.46%), while New Hampshire had the lowest (20.01%).

High depression clusters in Connecticut and Massachusetts were in urban areas, whereas in Maine and New Hampshire they were in rural areas.

Some neighborhoods in Massachusetts reported depression rates over 50% among the elderly.

Abstract

Rural residents report higher depression rates than their urban counterparts. The present descriptive study will compare community and neighborhood-level 65+ “ever-diagnosed” depression rates in five New England states: Connecticut (CT), Massachusetts (MA), Maine (ME), New Hampshire (NH), and Rhode Island (RI). The Healthy Aging Data Reports (HADRs) (www.healthyagingdatareports.org) are a comprehensive tool to spur community and policy action as they calculate community-level prevalence of 38 chronic diseases for each community in a state. Using Medicare Beneficiary Summary File (2020-2021), representing 100% of traditional beneficiaries. Small area estimation techniques were used to calculate age-sex adjusted community depression rates and over 150 other health indicators. Results varied across states with NH reporting the lowest community rate of 65+ depression in the sample (20.01%) and MA reporting the highest (54.46%). CT and MA reported the largest range in 65+ depression (CT:23.68-42.65%; MA:21.90-54.46%) with the highest rate clusters located near the biggest cities, in urban areas (CT:25.62-42.65%; MA:26.39-54.46%). Conversely, in ME and NH, the highest rate clusters were found in rural areas (NH:29.60-38.08%; ME:36.99-43.40%), states with a more traditional rural/urban threshold compared to the population dense states of CT, MA, and RI. In sum, the 2025 HADRs identified geographic disparities and overall high rate of 65+ community-level depression, with some communities reporting 65+ depression rates higher than 50% (neighborhoods in Springfield & Worcester, MA). The 2025 HADRs provide visualizations to make disparities evident; in this way, they can guide policy efforts to treat and address the growing mental health needs of the aging population.