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Main article: Clinical depression

This article considers the epidemiology of depression amongst adults for other age groups see:

Main article: Depression - Epidemiology in children
Main article: Depression - Epidemiology in older adults

“Depression is the most common mental disorder in community settings, and is a major cause of disability across the world. In 1990 it was the fourth most common cause of loss of disability-adjusted life years in the world, and by 2020 it is projected to become the second most common cause (World Bank, 1993). In 1994 it was estimated that about 1.5 million disability-adjusted life years were lost each year in the West as a result of depression (Murray et al., 1994).” [1]

Global disease burdenEdit

Recent review of the epidemiology of global disease again place major depressive disorder as a major contributor to the care burden of societies. These findings extend the information available from similar surveys in 1990 and 2000'. They confirm that depressive disorders are a leading direct cause of the global disease burden and show that MDD also contributes to the burden allocated to suicide and ischemic heart disease. The estimates of the global burden of depressive disorders reported in GBD 2010 are likely to be more accurate than those in previous GBD studies but are limited by factors such as the sparseness of data on depressive disorders from developing countries and the validity of the disability weights used to calculate YLDs. Even so, these findings reinforce the importance of treating depressive disorders as a public-health priority and of implementing cost-effective interventions to reduce their ubiquitous burden.

Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders.

Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%–10.8%) of global YLDs and dysthymia for 1.4% (0.9%–2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%–3.2%) of global DALYs and dysthymia for 0.5% (0.3%–0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%–3.8%) to 3.8% (3.0%–4.7%) of global DALYs.

The researchers collected data on the prevalence, incidence, remission rates, and duration of MDD and dysthymia and on the excess deaths caused by these disorders from published articles. They pooled these data using a statistical method called Bayesian meta-regression and calculated YLDs for MDD and dysthymia using disability weights collected in population surveys. MDD accounted for 8.2% of global YLDs in 2010, making it the second leading cause of years of life lived with a disability (YLDs). Dysthymia accounted for 1.4% of global YLDs. MDD and dysthymia were also leading causes of disability adjusted life years DALYs, accounting for 2.5% and 0.5% of global DALYs, respectively. The regional variation in the burden was greater for MDD than for dysthymia, the burden of depressive disorders was higher in women than men, the largest proportion of YLDs from depressive disorders occurred among adults of working age, and the global burden of depressive disorders increased by 37.5% between 1990 and 2010 because of population growth and ageing. Finally, MDD explained an additional 16 million DALYs and 4 million DALYs when it was considered as a risk factor for suicide and ischemic heart disease, respectively. This “attributable” burden increased the overall burden of depressive disorders to 3.8% of global DALYs.

So depression is a major cause of morbidity worldwide.[2] Lifetime prevalence varies widely, from 3% in Japan to 17% in the US. In most countries the number of people who would suffer from depression during their lives falls within an 8–12% range.[3][4] In North America the probability of having a major depressive episode within a year-long period is 3–5% for males and 8–10% for females.[5][6] Population studies have consistently shown major depression to about twice as common in women than in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this.[7] The relative increase in occurrence is related to pubertal development rather than chronological age and reaches adult ratios between the ages of 15 and 18, and appears associated with psychosocial more than hormonal factors.[7]

Risk factorsEdit

AgeEdit

People are most likely to suffer their first depressive episode between the ages of 30 and 40, and there is a second, smaller peak of incidence between ages 50 and 60.[8] The risk of major depression is increased with neurological conditions such as stroke, Parkinson's disease, or multiple sclerosis and during the first year after childbirth.[9][10] It is also more common after cardiovascular illnesses, and is related to a worse outcome.[11][12] Studies conflict on the prevalence of depression in the elderly, but most data suggests there is a reduction in this age group.[13]

Unemployment and povertyEdit

Depression is often associated with unemployment and poverty.[14] Major depression is currently the leading cause of disease burden in North America and other high-income countries, and the fourth leading cause worldwide. In the year 2030, it is predicted to be the second leading cause of disease burden worldwide after HIV, according to the World Health Organization.[15] Delay or failure in seeking treatment after relapse, and the failure of health professionals to provide treatment are two barriers to reducing disability.[16]


Epidemiologic studies of depression are difficult to interpret because of differing case definitions and variation in diagnostic procedures between studies. For example, Boyd and Weissman (1981) reviewed the area by dividing the data into studies of depressive symptoms, bipolar disorder, and nonbipolar depression.Using this classification the reported less variation in epidemiologic rates (point prevalence, incidence, and lifetime risk) than had been noted in previous reviews.


Epidemiology of depression by countryEdit

Epidemiology of depression and comorbid conditionsEdit

ReferencesEdit

  1. Depression: the treatment and management of depression in adults, National Clinical Practice Guideline 90, The National Institute for Health and Clinical Excellence (NICE), October 2009
  2. (2001). The world health report 2001 - Mental Health: New Understanding, New Hope. WHO website. World Health Organization. URL accessed on 2008-10-19.
  3. Andrade L, Caraveo-Anduaga JJ, Berglund P, et al. (2003). The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res 12 (1): 3–21.
  4. Kessler RC, Berglund P, Demler O, et al. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA 289 (203): 3095–105.
  5. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62 (6): 617–27.
  6. Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH (2000). A 40-year perspective on the prevalence of depression: The Stirling County Study. Archives of General Psychiatry 57 (3): 209–15.
  7. 7.0 7.1 Kuehner, C (2003). Gender differences in unipolar depression: An update of epidemiological findings and possible explanations. Acta Psychiatrica Scandinavica 108 (3): 163–74.
  8. Eaton WW, Anthony JC, Gallo J, et al. (1997). Natural history of diagnostic interview schedule/DSM-IV major depression. The Baltimore Epidemiologic Catchment Area follow-up. Archives of General Psychiatry 54: 993–99.
  9. Cite error: Invalid <ref> tag; no text was provided for refs named pmid9632411
  10. Rickards H (2005). Depression in neurological disorders: Parkinson's disease, multiple sclerosis, and stroke. Journal of Neurology Neurosurgery and Psychiatry 76: i48–i52.
  11. Strik JJ, Honig A, Maes M (May 2001). Depression and myocardial infarction: relationship between heart and mind. Progress in neuro-psychopharmacology & biological psychiatry 25 (4): 879–92.
  12. Alboni P, Favaron E, Paparella N, Sciammarella M, Pedaci M (April 2008). Is there an association between depression and cardiovascular mortality or sudden death?. Journal of cardiovascular medicine (Hagerstown, Md.) 9 (4): 356–62.
  13. Jorm AF (January 2000). Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychological Medicine 30 (1): 11–22.
  14. Weich S, Lewis G (1998). (fulltext) Poverty, unemployment, and common mental disorders: Population based cohort study. British Medical Journal 317: 115–19.
  15. Mathers CD, Loncar D (November 2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 3 (11): e442.
  16. Andrews G (July 2008). (fulltext) In Review: Reducing the Burden of Depression. Canadian Journal of Psychiatry 53 (7): 420–27.

Further readingEdit

Key Texts – BooksEdit

Silverman, C. (1968) The Epidemiology of Depression. London : Oxford University Press

Additional material – BooksEdit

Key Texts – PapersEdit

  • Boyd J H; Weissman M M (1981). Epidemiology of affective disorders. A reexamination and future directions. Archives of General Psychiatry, Vol. 38, No. 9, pp. 1039-46.
  • Bebbington PE, Dunn G, Jenkins R, Lewis G, Brugha T, Farrell M, et al. The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. Psychol Med 1998;28:9–19.
  • Lepine JP. Epidemiology, burden, and disability in

depression and anxiety. J Clin Psychiatry 2001; 62(Suppl 13):4–10.

  • Narrow WE. (1998).One year prevalence of depressive disorders among adults 18 and over in the U.S.: NIMH ECA prospective data. Population estimates based on U.S. Census estimated residential population age 18 and over on July 1,
  • Sullivan,P F Neale,M C & Kendler,K S (2000).Genetic Epidemiology of Major Depression: Review and Meta-Analysis Am J Psychiatry 157:1552-1562, Oct.Abstract
  • Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lepine JP, Newman SC, Rubin Stiper M, Wells JE, Wickramaratne PJ, Wittchen H, Yeh EK. Cross national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association, 1996; 276: 293 9.

Wells et al. 1996

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