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Major depression highly prevalent, comorbid in US
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Among American adults, the lifetime prevalence of DSM-5 major depressive disorder is more than 20%, and the disorder is associated with multiple comorbidities and impairments, according to nationally representative data published in JAMA Psychiatry.
“Updated knowledge is needed on the prevalence of MDD and its association with sociodemographic and clinical characteristics, including other psychiatric disorders, suicidality, impairment and treatment use,” Deborah S. Hasin, PhD, department of psychiatry, Columbia University Medical Center, and colleagues wrote. “In 2013, DSM-IV was replaced with the fifth edition of the DSM-5. Among changes in MDD, DSM-5 added specifiers. These specifiers have been studied in patients, but not national data; the proportion of MDD cases diagnosed as positive after bereavement has also not been studied.”
Researchers used the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions III to evaluate prevalence, sociodemographic and clinical correlates, psychiatric comorbidity, disability, course and treatment for 12-month and lifetime MDD, along with its specifiers and bereavement, in the U.S. They conducted in-person interviews with 36,309 survey participants to measure DSM-5 mood, anxiety, substance use and personality disorders. DSM-5 MDD specifiers included severity, anxious/distressed and mixed features.
Overall, 12-month and lifetime prevalence of MDD were 10.4% and 20.6%. Men had significantly lower odds of 12-month MDD (OR = 0.5; 95% CI, 0.46-0.55) compared with women, as did African American (OR = 0.6; 95% CI, 0.54-0.68), Asian/Pacific Islander (OR = 0.6; 95% CI, 0.45-0.67) and Hispanic (OR = 0.7; 95% CI, 0.62-0.78) adults compared with white adults. In addition, odds of 12-month MDD was higher in younger adults aged 18 to 29 years (OR = 3; 95% CI, 2.48-3.55) and those with incomes of $19,999 or less (OR = 1.7; 95% CI, 1.49-2.04). Major depressive disorder was associated with other psychiatric disorders, particularly generalized anxiety disorder (adjusted OR = 5.7 (95% CI, 4.98-6.5) and borderline personality disorder (aOR = 5.2; 95% CI, 4.7-5.74). MDD was also associated with substance use disorders, including alcohol use disorder (aOR = 1.8; 95% CI, 1.63-2.01) and any drug use disorder (aOR = 3.; 95% CI, 2.57-3.55). Most MDD cases were moderate (39.7%) or severe (49.5%).
Almost 70% with lifetime MDD reported some type of treatment. Among participants with MDD, 74.6% had the anxious/distressed specifier during their worst episode and 15.5% had the mixed-features specifier during any episode; 12.9% had episodes after someone close died that lasted less than 2 months. More than 13% attempted suicide during their worst episode. Major depressive disorder was also associated with impaired functioning, particularly for severe cases.
“This study on MDD prevalence, demographic and psychiatric correlates, disability, treatment use and specifiers can inform policymakers, clinicians and the public, as well as stimulate investigation in several areas,” Hasin and colleagues wrote. “The high prevalence of MDD among U.S. adults is a substantial concern given the personal, public health and economic burdens that the disorder imposes. Therefore, the need to reduce the prevalence of this disorder remains.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.