The Epidemiology of Major Depressive Disorder

  • Kessler R
  • Berglund P
  • Demler O
 et al. 
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Context Uncertainties exist about prevalence and correlates of major depressive dis- order (MDD). Objective To present nationally representative data on prevalence and correlates of MDDby Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM- IV) criteria, and on study patterns and correlates of treatment and treatment ad- equacy from the recently completed National Comorbidity Survey Replication (NCS-R). Design Face-to-face household survey conducted from February 2001 to Decem- ber 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 assess- ment scale (WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV. Results The prevalence of CIDIMDDfor lifetime was 16.2{%} (95{%} confidence inter- val [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 inde- pendently classified as clinically significant using the QIDS-SR, with 10.4{%} mild, 38.6{%} moderate, 38.0{%} severe, and 12.9{%} very severe.Meanepisode 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, withMDD only rarely primary. Although 51.6{%} (95{%} CI, 46.1-57.2) of 12-month cases received health care treatment forMDD,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-monthMDDbeing 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 im- pairment. While the recent increase in treatment is encouraging, inadequate treat- ment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement

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  • Rc Kessler

  • P Berglund

  • O Demler

  • R Jin

  • D Koretz

  • Kr Merikangas

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