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The epidemiology of major depressive disorder: consequences for society and for the individual

Author/s
Anna Mckeever, Mark Agius, Pavel Mohr
Citation
Issue 5 Winter 2018
CEPiP.2018.1.5-19
Abstract

Depression is a common and debilitating disorder that affects people from adolescence to old age. Its sub-groups are described and defined. The prevalence of depression is universally high: the cumulative prevalence in those aged 18-32 may be over 40%, although the retrospective figures, which depend on reliability of memory, are much lower, around 17% in one major study. The impact of depression extends beyond the individual with depressive symptoms. Depression adversely affects not only mental and phys-ical health but also the social and financial welfare of individuals and society. Major depressive disorder has a widespread prevalence. Symptom onset can be relatively early. There are genetic vulnerabilities and precipitation or accentuation can occur because of relatively unavoidable stressors. There is a longitudinal pattern of frequent recurrences with increasing frequency, severity, and consequences unless it is treat¬ed with effective maintenance strategies. However, the management of depression is characterised by severe underdiagnosis and under-treatment as well as inadequate prioritization of recurrence prevention by clinicians. Factors including sex, age, ethnicity, societal changes and common co-morbid conditions can all affect the prevalence of depression. These factors contribute to the morbidity and severity of the disease burden of depression. Early treatment for adequate duration can help to improve health, reduce morbidity and reduce the burden of depression. Treatment includes antidepressant medication for ade¬quate dose and duration, with due regard to the mode of action of the medication, in combination with appropriate psychotherapy. There are potential benefits in treating depression in ongoing illnesses such as stroke and coronary heart disease.

Keywords: depression, epidemiology, sex, age, ethnicity, treatment, cost

Cite as: Cutting Edge Psychiatry in Practice 2018, 5(1):5-19; https://doi.org/10.65031/hdaq7481

References

  1. Moffitt TE, Caspi A, Taylor A, Kokaua J, Milne BJ, Polanczyk G, Poulton R. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine. 2010 Jun;40(6):899-909. https://doi.org/10.1017/s0033291709991036
  2. Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annual Review of Public Health. 2013 Mar 18;34:119-38. https://doi.org/10.1146/annurev-publhealth-031912-114409
  3. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lépine JP. Cross-national epidemiology of major depression and bipolar disorder. JAMA. 1996 Jul 24;276(4):293-9 https://doi.org/10.1001/jama.1996.03540040037030
  4. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Geneva: World Health Organization; 2004.                 
  5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. https://doi.org/10.1007/s11019-013-9529-6
  6. Depression Guideline Panel. Depression in Primary Care: Volume 2. Treatment of Major Depression. Clinical Practice Guideline, Number 5 (AHCPR Publication No. 93-0551). Rockville, MD: US Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research. 1993. https://doi.org/10.1097/00004714-199408000-00026
  7. Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, Graaf RD, Vollebergh W, Dragomirecka E, Kohn R, Kessler RC, Kawakami N. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) surveys. International Journal of Methods in Psychiatric Research. 2003 Feb;12(1):3-21 https://doi.org/10.1002/mpr.138
  8. Murray CJ, Lopez AD. Evidence-based health policy - lessons from the Global Burden of Disease Study. Science. 1996 Nov 1;274(5288):740-3. https://doi.org/10.1126/science.274.5288.740
  9. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. The Lancet. 2012 Mar 17;379(9820):1056- 67. https://doi.org/10.1016/s0140-6736(11)60871-4
  10. Limosin F, Loze JY, Zylberman-Bouhassira M, Schmidt ME, Perrin E, Rouillon F. The course of depressive illness in general practice. The Canadian Journal of Psychiatry. 2004 Feb;49(2):119-23. https://doi.org/10.1177/070674370404900207
  11. Yiend J, Paykel E, Merritt R, Lester K, Doll H, Burns T. Long term outcome of primary care depression. Journal of Affective Disorders. 2009 Nov 1;118(1-3):79-86. https://doi.org/10.1016/j.jad.2009.01.026
  12. Katon W, Rutter C, Ludman EJ, Von Korff M, Lin E, Simon G, Bush T, Walker E, Unützer J. A randomized trial of relapse prevention of depression in primary care. Archives of General Psychiatry. 2001 Mar 1;58(3):241-7. https://doi.org/10.1001/archpsyc.58.3.241
  13. Greden JF. The burden of disease for treatment-resistant depression. The Journal of Clinical Psychiatry. 2001;62:26-31.      
  14. Üstün TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJ. Global burden of depressive disorders in the year 2000. The British Journal of Psychiatry. 2004 May;184(5):386-92. https://doi.org/10.1192/bjp.184.5.386
  15. Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L. The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology. 2011 Sep 1;21(9):655-79. https://doi.org/10.1016/j.euroneuro.2011.07.018
  16. Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK. The economic burden of depression in the United States: how did it change between 1990 and 2000? Journal of Clinical Psychiatry. 2003 Dec 12;64(12):1465-75. https://doi.org/10.4088/jcp.v64n1211
  17. Sobocki P, Lekander I, Borgström F, Ström O, Runeson B. The economic burden of depression in Sweden from 1997 to 2005. European Psychiatry. 2007 Apr 1;22(3):146-52. https://doi.org/10.1016/j.eurpsy.2006.10.006
  18. Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, Dodel R, Ekman M, Faravelli C, Fratiglioni L, Gannon B. Cost of disorders of the brain in Europe 2010. European Neuropsychopharmacology. 2011 Oct 1;21(10):718-79. https://doi.org/10.1016/j.euroneuro.2011.08.008
  19. Salvador-Carulla L, Bendeck M, Fernández A, Alberti C, Sabes-Figuera R, Molina C, Knapp M. Costs of depression in Catalonia (Spain). Journal of Affective Disorders. 2011 Jul 1;132(1-2):130-8. https://doi.org/10.1016/j.jad.2011.02.019
  20. Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003 Jun 18;289(23):3135-44. https://doi.org/10.1001/jama.289.23.3135
  21. Greenberg PE, Leong SA, Birnbaum HG, Robinson RL. The economic burden of depression with painful symptoms. The Journal of Clinical Psychiatry. 2003;64:17-23.      
  22. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003 Jun 18;289(23):3095-105. https://doi.org/10.1001/jama.289.23.3095
  23. Weissman MM, Feder A, Pilowsky DJ, Olfson M, Fuentes M, Blanco C, Lantigua R, Gameroff MJ, Shea S. Depressed mothers coming to primary care: maternal reports of problems with their children. Journal of Affective Disorders. 2004 Feb 1;78(2):93-100. https://doi.org/10.1016/s0165-0327(02)00301-4
  24. Pilowsky DJ, Wickramaratne PJ, Rush AJ, Hughes CW, Garber J, Malloy E, King CA, Cerda G, Sood AB, Alpert JE, Wisniewski SR. Children of currently depressed mothers: a STAR* D ancillary study. The Journal of Clinical Psychiatry. 2006 Jan. https://doi.org/10.4088/jcp.v67n0119
  25. Guffanti G, Gameroff MJ, Warner V, Talati A, Glatt CE, Wickramaratne P, Weissman MM. Heritability of major depressive and comorbid anxiety disorders in multi‐generational families at high risk for depression. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics. 2016 Dec;171(8):1072-9. https://doi.org/10.1002/ajmg.b.32477
  26. Burke L. The impact of maternal depression on familial relationships. International Review of Psychiatry. 2003 Jan 1;15(3):243-55.      
  27. Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R. Impact of maternal depression on infant nutritional status and illness: a cohort study. Archives of General Psychiatry. 2004 Sep 1;61(9):946-52. https://doi.org/10.1001/archpsyc.61.9.946
  28. Zung WW, Broadhead E, Roth ME. Prevalence of depressive symptoms in primary care. Journal of Family Practice. 1993 Oct 1;37(4):337-45.        
  29. Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. New England Journal of Medicine. 1999 Oct 28;341(18):1329-35. https://doi.org/10.1056/nejm199910283411801
  30. Kirmayer LJ, Robbins JM, Dworkind M, Yaffe MJ. Somatization and the recognition of depression and anxiety in primary care. The American Journal of Psychiatry. 1993 May 1;150(5):734. https://doi.org/10.1097/00005650-199408000-00004
  31. Bagayogo IP, Interian A, Escobar JI. Transcultural aspects of somatic symptoms in the context of depressive disorders. In: Cultural Psychiatry 2013 (Vol. 33, pp. 64-74). Karger Publishers. https://doi.org/10.1159/000350057
  32. Lecrubier Y: The burden of depression and anxiety in general medicine. The Journal of Clinical Psychiatry 2001; 62(Suppl 8):4- 9; discussion 10-1.
  33. Donoghue JM, Tylee A. The treatment of depression: prescribing patterns of antidepressants in primary care in the UK. The British Journal of Psychiatry. 1996 Feb;168(2):164-8. https://doi.org/10.1192/bjp.168.2.164
  34. Vos T, Haby MM, Barendregt JJ, Kruijshaar M, Corry J, Andrews G. The burden of major depression avoidable by longer-term treatment strategies. Archives of General Psychiatry. 2004 Nov 1;61(11):1097-103. https://doi.org/10.1001/archpsyc.61.11.1097
  35. Unützer J, Patrick DL, Simon G, Grembowski D, Walker E, Rutter C, Katon W. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: a 4-year prospective study. JAMA. 1997 May 28;277(20):1618-23. https://doi.org/10.1001/jama.1997.03540440052032
  36. Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG. Comorbidity of DSM–III–R major depressive disorder in the general population: results from the US National Comorbidity Survey. The British Journal of Psychiatry. 1996 Jun;168(S30):17-30. https://doi.org/10.1192/s0007125000298371
  37. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry. 1994 Jan 1;51(1):8-19. https://doi.org/10.1001/archpsyc.1994.03950010008002
  38. Burt VK, Stein K. Epidemiology of depression throughout the female life cycle. The Journal of Clinical Psychiatry. 2002;63:9-15.            
  39. Gater R, Tansella M, Korten A, Tiemens BG, Mavreas VG, Olatawura MO. Sex differences in the prevalence and detection of depressive and anxiety disorders in general health care settings: report from the World Health Organization Collaborative Study on Psychological Problems in General Health Care. Archives of General Psychiatry. 1998 May 1;55(5):405-13. https://doi.org/10.1001/archpsyc.55.5.405
  40. Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB. Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence. Journal of Affective Disorders. 1993 Oct 1;29(2-3):85-96. https://doi.org/10.1016/0165-0327(93)90026-g
  41. Kanowski S. Age-dependent epidemiology of depression. Gerontology. 1994;40(Suppl. 1):1-4.          
  42. Waheed W, Husain N, Allen G, Atif N, Aseem S, Waquas A, Garrett C, Sheikh S, Syed A, Gask L, Bower P. Recruitment strategies for British South Asians in 5 depression trials: a mixed method study. Journal of Affective Disorders. 2015 Oct 1;185:195-203. https://doi.org/10.1016/j.jad.2015.06.046
  43. Williams ED, Tillin T, Richards M, Tuson C, Chaturvedi N, Hughes AD, Stewart R. Depressive symptoms are doubled in older British South Asian and Black Caribbean people compared with Europeans: associations with excess co-morbidity and socioeconomic disadvantage. Psychological Medicine. 2015 Jul;45(9):1861-71. https://doi.org/10.1017/s0033291714002967
  44. Taylor R, Brown JS, Weinman J. A comparison of the illness perceptions of North Indian and white British women. Journal of Mental Health. 2013 Feb 1;22(1):22-32. https://doi.org/10.3109/09638237.2012.734664
  45. Commander MJ, Odell SM, Surtees PG, Sashidharan SP. Care pathways for south Asian and white people with depressive and anxiety disorders in the community. Social Psychiatry and Psychiatric Epidemiology. 2004 Apr 1;39(4):259-64. https://doi.org/10.1007/s00127-004-0736-6
  46. Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy III FV, Brody D. Physical symptoms in primary care: predictors of psychiatric disorders and functional impairment. Archives of Family Medicine. 1994 Sep 1;3(9):774. https://doi.org/10.1001/archfami.3.9.774
  47. Bhui K, Bhugra D, Goldberg D, Sauer J, Tylee A. Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms. Transcultural Psychiatry. 2004 Sep;41(3):307-22. https://doi.org/10.1177/1363461504045642
  48. Escobar JI, Burnam MA, Karno M, Forsythe A, Golding JM. Somatization in the community. Archives of General Psychiatry. 1987 Aug 1;44(8):713-8.
  49. Brown C, Schulberg HC, Madonia MJ. Clinical presentations of major depression by African Americans and whites in primary medical care practice. Journal of Affective Disorders. 1996 Dec 16;41(3):181-91. https://doi.org/10.1016/s0165-0327(96)00085-7
  50. Ali S, Davies MJ, Taub NA, Stone MA, Khunti K. Prevalence of diagnosed depression in South Asian and white European people with type 1 and type 2 diabetes mellitus in a UK secondary care population. Postgraduate Medical Journal. 2009 May 1;85(1003):238-43. https://doi.org/10.1136/pgmj.2008.074641
  51. Aujla N, Skinner TC, Khunti K, Davies MJ. The prevalence of depressive symptoms in a white European and South Asian population with impaired glucose regulation and screen‐detected Type 2 diabetes mellitus: a comparison of two screening tools. Diabetic Medicine. 2010 Aug;27(8):896-905. https://doi.org/10.1111/j.1464-5491.2010.03042.x
  52. Kendrick T, Stuart B, Newell C, Geraghty AW, Moore M. Changes in rates of recorded depression in English primary care 2003–2013: time trend analyses of effects of the economic recession, and the GP contract quality outcomes framework (QOF). Journal of Affective Disorders. 2015 Jul 15;180:68-78. https://doi.org/10.1016/j.jad.2015.03.040
  53. Marcus M, Yasamy MT, Van Ommeren M, Chisholm D, Saxena S. WHO Department of Mental Health and Substance Abuse. Depression: A Global Public Health Concern. Geneva: World Health Organization. 2012. https://doi.org/10.1037/e517532013-004
  54. Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller TI, Rice JA. Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. Journal of Affective Disorders. 1998 Sep 1;50(2-3):97-108. https://doi.org/10.1016/s0165-0327(98)00138-4
  55. Judd LL, Schettler PJ, Rush AJ, Coryell WH, Fiedorowicz JG, Solomon DA. A New Empirical Definition of Major Depressive Episode Recovery and Its Positive Impact on Future Course of Illness. The Journal of Clinical Psychiatry. 2016 Aug;77(8):1065-73. https://doi.org/10.4088/jcp.15m09918
  56. Judd LL, Paulus MJ, Schettler PJ, Akiskal HS, Endicott J, Leon AC, Maser JD, Mueller T, Solomon DA, Keller MB. Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? American Journal of Psychiatry. 2000 Sep 1;157(9):1501-4. https://doi.org/10.1176/appi.ajp.157.9.1501
  57. Paykel ES, Ramana R, Cooper Z, Hayhurst H, Kerr J, Barocka A. Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine. 1995 Nov;25(6):1171-80. https://doi.org/10.1017/s0033291700033146
  58. Mouchabac S, Ferreri M, Cabanac F, Bitton M. Residual symptoms after a treated major depressive disorder: in practice ambulatory observatory carried out of city. L'Encephale. 2003;29(5):438-44.       
  59. Bakish D: New standard of depression treatment:remission and full recovery. The Journal of Clinical Psychiatry 2001;62(Suppl 26):5-9.                 
  60. Fava M, Mallinckrodt CH, Detke MJ, Watkin JG, Wohlreich MM. The effect of duloxetine on painful physical symptoms in depressed patients: do improvements in these symptoms result in higher remission rates? The Journal of Clinical Psychiatry 2004; 65:521-30. https://doi.org/10.4088/jcp.v65n0411
  61. Paykel ES, Freeling P, Hollyman JA. Are tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry. 1988;21(1):15-8. https://doi.org/10.1055/s-2007-1014639
  62. Kendrick T, Chatwin J, Dowrick C, Tylee A, Morriss R, Peveler R, Leese M, McCrone P, Harris T, Moore M, Byng R. 2009. Randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of selective serotonin reuptake inhibitors plus supportive care, versus supportive care alone, for mild to moderate depression with somatic symptoms in primary care: the THREAD (THREshold for AntiDepressant response) study. Health Technology Assessment, 13(22), pp.i-182. https://doi.org/10.3310/hta13220
  63. Evans-Lacko S, Koeser L, Knapp M, Longhitano C, Zohar J, Kuhn K. Evaluating the economic impact of screening and treatment for depression in the workplace. European Neuropsychopharmacology. 2016 Jun 1;26(6):1004-13. https://doi.org/10.1016/j.euroneuro.2016.03.005
  64. Sado M, Knapp M, Yamauchi K, Fujisawa D, So M, Nakagawa A, Kikuchi T, Ono Y. Cost-effectiveness of combination therapy versus antidepressant therapy for management of depression in Japan. Australian and New Zealand Journal of Psychiatry. 2009 Jan 1;43(6):539-47. https://doi.org/10.1080/00048670902873664
  65. Paykel ES, Priest RG. Recognition and management of depression in general practice: consensus statement. BMJ. 1992 Nov 14;305(6863):1198. https://doi.org/10.1136/bmj.305.6863.1198
  66. National Institute for Health and Care Excellence (NICE). Depression in adults: recognition and management: Clinical guideline [CG90]. National Institute for Health and Care Excellence (NICE); 2018. https://doi.org/10.1007/978-1-349-94186-5_836
  67. Banerjee S, Hellier J, Romer R, Dewey M, Knapp M, Ballard C, Baldwin R, Bentham P, Fox C, Holmes C, Katona C. Study of the use of antidepressants for depression in dementia: the HTA-SADD trial-a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technology Assessment. 2013;17(7). https://doi.org/10.3310/hta17070
  68. Banerjee S, Hellier J, Dewey M, Romeo R, Ballard C, Baldwin R, Bentham P, Fox C, Holmes C, Katona C, Knapp M. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. The Lancet. 2011 Jul 30;378(9789):403-11. https://doi.org/10.1016/s0140-6736(11)60830-1
  69. Romeo R, Knapp M, Hellier J, Dewey M, Ballard C, Baldwin R, Bentham P, Burns A, Fox C, Holmes C, Katona C. Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial. The British Journal of Psychiatry. 2013 Feb;202(2):121-8. https://doi.org/10.1192/bjp.bp.112.115212
  70. Faris R, Purcell H, Henein MY, Coats AJ. Clinical depression is common and significantly associated with reduced survival in patients with non‐ischaemic heart failure. European Journal of Heart Failure. 2002 Aug;4(4):541-51. https://doi.org/10.1016/s1388-9842(02)00101-0
  71. Williams LS, Ghose SS, Swindle RW. Depression and other mental health diagnoses increase mortality risk after ischemic stroke. American Journal of Psychiatry. 2004 Jun 1;161(6):1090-5. https://doi.org/10.1176/appi.ajp.161.6.1090
  72. Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. Journal of Psychosomatic Research. 2002 Oct 1;53(4):897-902. https://doi.org/10.1016/s0022-3999(02)00311-2
  73. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine. 2004 Nov 1;66(6):802-13. https://doi.org/10.1097/01.psy.0000146332.53619.b2
  74. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146,538 participants in 54 observational studies. European Heart Journal. 2006 Nov 2;27(23):2763-74. https://doi.org/10.1093/eurheartj/ehl338