Rule-Based Modeling of Chronic Disease Epidemiology: Elderly Depression as an Illustration

Background: Rule-based Modeling (RBM) is a computer simulation modeling methodology already used to model infectious diseases. Extending this technique to the assessment of chronic diseases, mixing quantitative and qualitative data appear to be a promising alternative to classical methods. Elderly depression reveals an important source of comorbidities. Yet, the intertwined relationship between late-life events and the social support of the elderly person remains difficult to capture. We illustrate the usefulness of RBM in modeling chronic diseases using the example of elderly depression in Belgium. Methods: We defined a conceptual framework of interactions between late-life events and social support impacting elderly depression. This conceptual framework was underpinned by experts' opinions elicited through a questionnaire. Several scenarios were implemented successively to better mimic the real population, and to explore a treatment effect and a socio-economic distinction. The simulated patterns of depression by age were compared with empirical patterns retrieved from the Belgian Health Interview Survey. Results: Simulations were run using different groupings of experts' opinions on the parameters. The results indicate that the conceptual framework can reflect a realistic evolution of the prevalence of depression. Indeed, simulations combining the opinions of well-selected experts and a treatment effect showed no significant difference with the empirical pattern. Conclusions: Our conceptual framework together with a quantification of parameters through elicited expert opinions improves the insights into possible dynamics driving elderly depression. While RBM does not require high-level skill in mathematics or computer programming, the whole implementation process provides a powerful tool to learn about complex chronic diseases, combining advantages of both quantitative and qualitative approaches.