References pertaining to depression and epidemiology:

Arch Gen Psychiatry. 2007 Mar;64(3):305-15.

Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life.

Williams DR, Gonzalez HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, Jackson JS.

Department of Sociology, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA. dwilliam@hsph.harvard.edu

CONTEXT: Little is known about the relationship between race/ethnicity and depression among US blacks. OBJECTIVE: To estimate the prevalence, persistence, treatment, and disability of depression in African Americans, Caribbean blacks, and non-Hispanic whites in the National Survey of American Life. DESIGN: A slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. SETTING: National household probability samples of noninstitutionalized African Americans, Caribbean blacks, and non-Hispanic whites in the United States conducted between February 2, 2001, and June 30, 2003. PARTICIPANTS: A total of 3570 African Americans, 1621 Caribbean blacks, and 891 non-Hispanic whites aged 18 years and older (N = 6082). MAIN OUTCOME MEASURES: Lifetime and 12-month diagnoses of DSM-IV major depressive disorder (MDD), 12-month mental health services use, and MDD disability as quantified using the Sheehan Disability Scale and the World Health Organization's Disability Assessment Schedule II. RESULTS: Lifetime MDD prevalence estimates were highest for whites (17.9%), followed by Caribbean blacks (12.9%) and African Americans (10.4%); however, 12-month MDD estimates across groups were similar. The chronicity of MDD was higher for both black groups (56.5% for African Americans and 56.0% for Caribbean blacks) than for whites (38.6%). Fewer than half of the African Americans (45.0%) and fewer than a quarter (24.3%) of the Caribbean blacks who met the criteria received any form of MDD therapy. In addition, relative to whites, both black groups were more likely to rate their MDD as severe or very severe and more disabling. CONCLUSIONS: When MDD affects African Americans and Caribbean blacks, it is usually untreated and is more severe and disabling compared with that in non-Hispanic whites. The burden of mental disorders, especially depressive disorders, may be higher among US blacks than in US whites.

Publication Types:
Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

PMID: 17339519 [PubMed - indexed for MEDLINE]

Am J Psychiatry. 2006 Dec;163(12):2141-7.

Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002.

Compton WM, Conway KP, Stinson FS, Grant BF.

Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, NIH, M.S. 9304, 5635 Fishers Lane, Bethesda, MD 20892-9304, USA.

OBJECTIVE: The authors examined changes in the prevalence of major depression in the United States between 1991-1992 and 2001-2002 and sought to determine whether changes in depression rates were associated with changes in rates of comorbid substance use disorder. METHOD: Data were drawn from two large (Ns exceeding 42,000) cross-sectional surveys of representative samples of the U.S. population conducted 10 years apart. Both surveys used face-to-face interviews, the same diagnostic criteria, and consistent assessment instruments. Rates of past-year major depressive episode in the total samples and among subjects with and without co-occurring substance use disorders in major demographic groups were compared. RESULTS: From 1991-1992 to 2001-2002, the prevalence of major depression among U.S. adults increased from 3.33% to 7.06%. Increases were statistically significant for whites, blacks, and Hispanics and for all age groups. For Hispanic men overall and Hispanic women 18-29 years of age, rates increased but not significantly. The hypothesis that increases in the rates of depression could be explained by concomitant increases in co-occurring substance use disorders was supported only for black men 18-29 years of age. CONCLUSIONS: Rates of major depression rose markedly over the past decade in the United States, and increases were noted for most sociodemographic subgroups of the population. If the prevalence continues to increase at the rate it did during the past decade, the demand for services will increase dramatically in the coming years.

Publication Types:
Comparative Study
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural

PMID: 17151166 [PubMed - indexed for MEDLINE]

Arch Gen Psychiatry. 2005 Oct;62(10):1097-106.

Comment in:
Evid Based Ment Health. 2006 May;9(2):59.

Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions.

Hasin DS, Goodwin RD, Stinson FS, Grant BF.

Mailman School of Public Health, Division of Epidemiology and College of Physicians and Surgeons, Department of Psychiatry, Columbia University, New York, NY, USA.

OBJECTIVE: To present nationally representative data on 12-month and lifetime prevalence, correlates, and comorbidity of DSM-IV major depressive disorder (MDD) among adults in the United States. DESIGN/SETTING/ PARTICIPANTS: Face-to-face survey of more than 43 000 adults aged 18 years and older residing in households and group quarters in the United States. MAIN OUTCOME MEASURES: Prevalence and associations of MDD with sociodemographic correlates and Axis I and II disorders. RESULTS: The prevalence of 12-month and lifetime DSM-IV MDD was 5.28% (95% confidence interval, 4.98-5.57) and 13.23% (95% confidence interval, 12.64-13.81), respectively. Being female; Native American; middle-aged; widowed, separated, or divorced; and low income increased risk, and being Asian, Hispanic, or black decreased risk (P<.05). Women were significantly more likely to receive treatment than men. Both current and lifetime MDD were significantly associated with other specific psychiatric disorders, notably substance dependence, panic and generalized anxiety disorder, and several personality disorders. CONCLUSIONS: This large survey suggests a higher prevalence of MDD in the US population than large-sample estimates from the 1980s and 1990s. The shift in highest lifetime risk from young to middle-aged adults is an important transformation in the distribution of MDD in the United States and specificity in risk for an age-period cohort. Associations between MDD and Axis I and II disorders were strong and significant, with variation within broad categories by specific diagnoses signaling the need for attention to the genetic and environmental reasons for such variation, as well as the implications for treatment response.

Publication Types:
Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

PMID: 16203955 [PubMed - indexed for MEDLINE]

Am J Public Health. 2005 Jun;95(6):998-1000.

Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III.

Riolo SA, Nguyen TA, Greden JF, King CA.

Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI 48105-0766, USA. sriolo@umich.edu

Depression prevalence was examined by race/ethnicity in a nationally representative sample. The Diagnostic Interview Schedule was administered to 8449 (response rate=96.1%) participants (aged 15-40 years). Prevalence of major depressive disorder was significantly higher in Whites than in African Americans and Mexican Americans; the opposite pattern was found for dysthymic disorder. Across racial/ethnic groups, poverty was a significant risk factor for major depressive disorder, but significant interactions occurred between race/ethnicity, gender, and education in relation to prevalence of dysthymic disorder.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 15914823 [PubMed - indexed for MEDLINE]

Manag Care. 2004 Jun;13(6 Suppl Depression):9-16.

Prevalence and economic effects of depression.

Bloom BS.

Department of Medicine, School of Medicine, University of Pennsylvania, USA.

The lifetime risk of major depression among Americans is 17 percent, with as many as 10 percent suffering from depression in any 1-year period. The author reviews the epidemiology of depression, costs of treatment and nontreatment, and its economic impact on quality of life and daily function. This review also examines ways to improve value for money spent relative to this disease.

Publication Types:
Review

PMID: 15293766 [PubMed - indexed for MEDLINE]

JAMA. 2003 Jun 18;289(23):3095-105.

Comment in: JAMA. 2003 Oct 15;290(15):1991-2; author reply 1992-3. JAMA. 2003 Oct 15;290(15):1991; author reply 1992-3. JAMA. 2003 Oct 15;290(15):1992; author reply 1992-3.

The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).

Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS; National Comorbidity Survey Replication.

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. NCS@hcp.med.harvard.edu

CONTEXT: Uncertainties exist about prevalence and correlates of major depressive disorder (MDD). OBJECTIVE: To present nationally representative data on prevalence and correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, and on study patterns and correlates of treatment and treatment adequacy from the recently completed National Comorbidity Survey Replication (NCS-R). DESIGN: Face-to-face household survey conducted from February 2001 to December 2002. SETTING: The 48 contiguous United States. PARTICIPANTS: Household residents ages 18 years or older (N = 9090) who responded to the NCS-R survey. MAIN OUTCOME MEASURES: Prevalence and correlates of MDD using the World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI), 12-month severity with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), the Sheehan Disability Scale (SDS), and the WHO disability assessment scale (WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV. RESULTS: The prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval [CI], 15.1-17.3)(32.6-35.1 million US adults) and for 12-month was 6.6% (95% CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases were independently classified as clinically significant using the QIDS-SR, with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured by SDS was substantial as indicated by 59.3% of 12-month cases with severe or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%) cases had comorbid CIDI/DSM-IV disorders, with MDD only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases received health care treatment for MDD, treatment was adequate in only 41.9% (95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2) of 12-month MDD being adequately treated. Sociodemographic correlates of treatment were far less numerous than those of prevalence. CONCLUSIONS: Major depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment. While the recent increase in treatment is encouraging, inadequate treatment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement.

Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

PMID: 12813115 [PubMed - indexed for MEDLINE]

Am J Manag Care. 2001 Sep;7(11 Suppl):S353-66.

Current perspectives on the diagnosis and treatment of major depressive disorder.

Nierenberg AA.

Each year in America approximately 6 million people suffer from depression at a cost of more than $16 billion. People who are depressed have more medical illnesses than those without depression and make greater use of healthcare services. In a 15-month period after having been diagnosed with depression, sufferers are 4 times more likely to die as those who do not have depression. Almost 60% of suicides have their roots in major depression, and 15% of those admitted to a psychiatric hospital for depression eventually kill themselves. Although depression is highly treatable, only one third of sufferers receive suitable treatment. The reason for underdiagnosis is 2-fold. Physicians may fail to recognize depression and sufferers may actively deny it. A family history of depression is an important cause in those who suffer recurrent episodes. Major depressive disorder is the most common type of depression and, unless treated, resolves by itself in 6 months to a year less than 40% of the time. Depressive symptoms can be found in as many as 30% of those who abuse alcohol, so abstinence is crucial to treatment. Contrary to popular belief, depression is not a normal part of aging, although it can occur in elderly people who have severe medical and psychosocial problems. The goal of pharmacotherapy is the reduction and ultimate removal of all signs and symptoms of depression. More than 2 dozen drugs with 7 distinct mechanisms of action are available to treat depression, with the clinical goal being remission. Whereas psychotherapy is a treatment option, by itself it tends to be effective in only a limited group of highly motivated individuals who have less severe forms of depression. As a result, treatment outcomes are better when pharmacologic antidepressant treatment and psychotherapy are combined.

Publication Types:
Review

PMID: 11570026 [PubMed - indexed for MEDLINE]

Arch Gen Psychiatry. 2000 Mar;57(3):209-15.

Comment in:
Arch Gen Psychiatry. 2000 Mar;57(3):223-4. Arch Gen Psychiatry. 2000 Mar;57(3):227-8.

A 40-year perspective on the prevalence of depression: the Stirling County Study.

Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH.

Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston 02129-2000, USA. murphy@a1.mgh.harvard.edu

BACKGROUND: According to epidemiologic studies that use recall of lifetime episodes, the prevalence of depression is increasing. This report from the Stirling County Study compares rates of current depression among representative samples of adults from a population in Atlantic Canada. METHODS: Sample sizes were 1003, 1201, and 1396 in 1952, 1970, and 1992, respectively. The depression component of the study's method, the DPAX (DP for depression and AX for anxiety), was employed. The original procedure (DPAX-1) was applied in all years. A revision (DPAX-2) was used in 1970 and 1992. The Diagnostic Interview Schedule (DIS) was also used in 1992. RESULTS: With the DPAX-1, the overall prevalence of current depression was steady at 5% over the 2 early samples but declined in 1992 because of vernacular changes referring to dysphoria. The DPAX-2 gave a stable overall prevalence of 5% in the 2 recent samples, but indicated that women and younger people were at greater risk in 1992 than in 1970. The DIS, like the DPAX-2, found a current 1992 rate of 5% for major depressive episodes combined with dysthymia. Recalled lifetime rates using the DIS showed the same profile interpreted in other studies as suggesting an increase in depression over time. CONCLUSIONS: Three samples over a 40-year period showed a stable current prevalence of depression using the DPAX methods that was comparable in 1992 with the current rates using the DIS. This casts doubt on the interpretation that depression is generally increasing. Within the overall steady rate observed in this study, historical change was a matter of redistribution by sex and age, with a higher rate among younger women being of recent origin.

Publication Types:
Research Support, U.S. Gov't, P.H.S.

PMID: 10711905 [PubMed - indexed for MEDLINE]

J Ment Health Policy Econ. 1999 Sep 1;2(3):123-131.

Prevalence and patterns of major depressive disorder in the United States labor force.

Marcotte DE, Wilcox-Gok V, Redmon PD.

Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, MD 21250, USA, marcotte@umbc.edu

BACKGROUND AND AIMS OF THE STUDY: In this paper, we identify the 12-month and lifetime prevalence of major depressive disorder in and out of the labor force, and among the employed and unemployed. We examine whether prevalence by labor force and employment status varies by gender and over the life cycle. Finally, we examine whether people can "recover" from depression with time by identifying patterns of labor force participation and employment as time since most recent episode passes. METHODS: We examine data collected as part of the National Comorbidity Survey, a survey representative of the population of the United States designed to identify the prevalence of major mental illnesses. The National Comorbidity Study identified cases of major depression via the Composite International Diagnostic Interview. Using these data, we estimate univariate and bivariate frequency distributions of major depressive disorder. We also estimate a set of multivariate models to identify the effect of a variety of dimensions of major depression on the propensity to participate in the labor force, and be employed if participating. RESULTS: Lifetime and 12-month prevalence rates of depression are similar in and out of the labor force. Within the labor force, however, depression is strongly associated with unemployment. The negative relationship between depressive disorder and employment is particularly strong for middle age workers. Depression and the number of depressive episodes have a differing pattern of effects on labor market outcomes for men and women. We find evidence that labor force participation and employment rates for people with a history of depression increase significantly over time in the absence of additional depressive episodes. DISCUSSION: Labor market status represents an important dimension along which prevalence of major depression varies. The relationship between depression and employment status is particularly strong for middle aged persons, but becomes weaker as time passes since the last depressive episode. Continued exploration of the association between work (or lack of work) and depression may ultimately help in the prediction, treatment and assessment of the illness. IMPLICATIONS FOR PRACTICE AND POLICY: These results present a basic set of facts about the relationship between major depressive disorder and labor market outcomes. We have not, however, attempted to sort out the complexities of this relationship here. These complexities arise at almost every turn. For instance, the high level of prevalence of depression among the unemployed may be due to the possibility that the stresses associated with unemployment trigger depressive episodes or to the possibility that workers who are depressed are more likely to be fired or quit. IMPLICATIONS FOR FURTHER RESEARCH: Our continuing research attempts to address these problems. Understanding when and how depression affects labor market outcomes and when and how labor market outcomes affect depression is an important endeavor for those interested in treating the disease and understanding its consequences.

PMID: 11967420 [PubMed - as supplied by publisher]

Arch Gen Psychiatry. 1997 Nov;54(11):993-9.

Comment in:
Arch Gen Psychiatry. 1997 Nov;54(11):989-91.

Natural history of Diagnostic Interview Schedule/DSM-IV major depression. The Baltimore Epidemiologic Catchment Area follow-up.

Eaton WW, Anthony JC, Gallo J, Cai G, Tien A, Romanoski A, Lyketsos C, Chen LS.

Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md., USA.

BACKGROUND: Natural history can be characterized by incidence, recurrence, and duration of episodes. Research on the incidence of major depression is rare; studies of recurrence and duration are limited to clinical samples. METHODS: The Baltimore, Md, site of the Epidemiologic Catchment Area Program followed up its 1981 baseline cohort of 3481 respondents with an additional assessment in 1993 to 1996. Interviews were obtained from 1920 respondents (73% of the survivors). The Diagnostic Interview Schedule and the same survey procedures as in 1981 were used, augmented with a Life Chart Interview for dating the onset and duration of syndromes. RESULTS: There were 71 new cases of Diagnostic interview Schedule/DSM-IV major depression and 23,698 person-years of exposure, generating an estimated incidence of 3.0 per 1000 per year. Incidence peaked while subjects were in their 30s, with a smaller peak when they were in their 50s. Prodromal symptoms often occurred many years before the full criteria for diagnosis were met. Women were at higher risk for becoming new cases but had neither higher risk for recurrence nor longer episodes than men. Episodes of depression lasted for 12 weeks. The duration of an episode, and time to an episode-free year, was longer in the first episode than in recurrent episodes. CONCLUSIONS: The incidence estimated in this study is consistent with that found in the few other similar studies performed. The bimodality of onset suggests the value of further exploring the heterogeneity of depression via its natural history. Reported differences in prevalence between men and women seem to be due to differences in incidence, not chronicity.

Publication Types:
Research Support, U.S. Gov't, P.H.S.

PMID: 9366655 [PubMed - indexed for MEDLINE]

Am J Psychiatry. 1994 Jul;151(7):979-86.

The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey.

Blazer DG, Kessler RC, McGonagle KA, Swartz MS.

Duke University Medical Center, Durham, NC 27710.

OBJECTIVE: Major depression is a frequent and disabling psychiatric disorder in the United States. This report examines the prevalence and risk factor profile of both pure and comorbid major depression according to data from the National Comorbidity Survey. METHOD: To estimate the prevalence of psychiatric comorbidity in the United States, a national sample of 8,098 persons 15-54 years of age from the 48 conterminous states was surveyed with a modified version of the Composite International Diagnostic Interview. Results: From the survey data the prevalence of current (30-day) major depression was estimated to be 4.9%, with a relatively higher prevalence in females, young adults, and persons with less than a college education. The prevalence estimate for lifetime major depression was 17.1%, with a similar demographic distribution. Both 30-day and lifetime prevalence estimates were higher than estimates from the earlier Epidemiologic Catchment Area study. When pure major depression was compared with major depression co-occurring with other psychiatric disorders, the risk factor profiles exhibited clear differences. CONCLUSIONS: These findings suggest a greater burden of major depression in community-dwelling persons than has been estimated from previous community samples. The risk factor profile showed significant differences between persons with pure and combined major depression.

Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

PMID: 8010383 [PubMed - indexed for MEDLINE]

J Affect Disord. 1993 Oct-Nov;29(2-3):85-96.

Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence.

Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB.

Institute for Social Research, University of Michigan, Ann Arbor.

Basic epidemiologic prevalence data are presented on sex differences in DSM-III-R major depressive episodes (MDE). The data come from the National Comorbidity Survey (NCS), the first survey in the U.S. to administer a structured psychiatric interview to a nationally representative sample of the general population. Consistent with previous research, women are approximately 1.7 times as likely as men to report a lifetime history of MDE. Age of onset analysis shows that this sex difference begins in early adolescence and persists through the mid-50s. Women also have a much higher rate of 12-month depression than men. However, women with a history of depression do not differ from men with a history of depression in either the probability of being chronically depressed in the past year or in the probability of having an acute recurrence in the past year. This means that the higher prevalence of 12-month depression among women than men is largely due to women having a higher risk of first onset. The implications of these results for future research are discussed in a closing section of the paper.

Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

PMID: 8300981 [PubMed - indexed for MEDLINE]