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Research problem and specific questions: This project aims to contribute key knowledge for optimizing prevention, intervention, and care management of old-age depression by disentangling the complexities of this common and burdensome condition. Compared to earlier in life, old-age depression is characterized by distinct symptom patterns and a more complex clinical course, precipitating intricate care needs and increased healthcare use among older adults. The drivers of these complexities remain poorly understood, and we aim to conduct three interconnected sub-projects scrutinizing them. Specifically, we will: 1) investigate the role of psychosocial, behavioral, and socioeconomic determinants of diverse depressive symptom patterns and transitions between them

2) assess health and survival consequences of different depressive symptom patterns

and 3) evaluate healthcare utilization in people with old-age depression, focusing on complex and avoidable transitions across care settings.Data and method: Longitudinal data on more than 7,000 older adults from four population-based cohorts included in the Swedish National Study on Aging and Care (SNAC) and harmonized via the National E-Infrastructure for Aging Research (NEAR) will be used. We will exploit more than 20 years of already-collected follow-up data, gathered using shared instruments across cohorts. Multi-state transition models will be used to capture diverse shifts across depressive states (no depression, subsyndromal depression, major depression) and care settings (home, formal care, hospital, institution), as well as their associated determinants and consequences.Relevance and utilization: Depression in older adults is a cause of major distress for patients, their families, and the healthcare system. A better understanding of its fluctuating course is required to identify strategies promoting prevention, recovery, and care continuity. Planned in close connection with patient organizations and care provider networks, this project will bring about knowledge sought by multiple stakeholders, ensuring that older adults with depression experience old age with the dignity they deserve.Plan for project realization: The project will be carried out by a multidisciplinary team with expertise in geriatric mental health, epidemiology, and care sciences. Its results will be deployed through the National Association for Social and Mental Health (RSMH). Researcher salaries constitute key budgetary items.