12-month Major Depressive Disorder Research Articles

Religious Participation and DSM IV Major Depressive Disorder Among Black Caribbeans in the United States

This study examines the relationship between religious involvement and 12-month and lifetime DSM-IV major depressive disorder (MDD) within a nationally representative sample of Black Caribbean adults. MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview (WMH-CIDI). Religious involvement included measures of religious coping, organizational and nonorganizational involvement, and subjective religiosity. Study findings indicate that religious involvement is associated with 12-month and lifetime prevalence of MDD. Multivariate relationships between religious involvement and MDD indicate lower prevalence of 12-month and lifetime MDD among persons who use religious coping and characterize themselves as being religious (for lifetime prevalence only); persons who frequently listen to religious radio programs report higher lifetime MDD. Lower rates of 12-month and lifetime MDD are noted for persons who attend religious services at least once a week (as compared to both higher and lower levels of attendance), indicating a curvilinear relationship. The findings are discussed in relation to previous research on religion and mental health concerns, conceptual models of the role of religion in mental health (e.g., prevention, resource mobilization) that specify multiple and often divergent pathways and mechanisms of religious effects on health outcomes, and the role of religion among Caribbean Blacks.

DSM-IV 12-month and lifetime major depressive disorder and romantic relationships among African Americans

This brief report examines the association between marital and relationship status and 12-month and lifetime prevalence of major depressive disorder (MDD) among African Americans. Previous work has found that adults with major depressive disorder are less likely to be married or in a cohabiting relationship. This report extends previous research by investigating whether unmarried, non-cohabiting African Americans with depression are also less likely to be involved in a romantic relationship. Data are from the African American sub-sample (n=3570) of the National Survey of American Life (NSAL; 2001-2003). The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime MDD. Weighted logistic regression was used. The findings indicate that for both 12-month and lifetime major depressive disorder, African Americans who are depressed are not only less likely to be married; they are also significantly less likely to be involved in a romantic relationship. This is particularly the case for 12-month depression. Due to limitations in the number of cohabiting respondents, currently married and cohabiting respondents were combined into a single category. The findings of this brief report highlight the importance of changes in marital and relationship circumstances of the U.S. population for research and practice on depression and other psychiatric disorders. Our study provides evidence for a more nuanced approach in which examining marital and romantic relationship status together promotes a better understanding of the impact of major depression on romantic unions.

Longitudinal predictors of first time depression treatment utilization among adults with depressive disorders

Depressive disorders are a growing public health concern, however, a substantial number of depressed individuals do not receive treatment. This study examined the longitudinal predictors of receiving depression treatment among adults with persistent depressive disorders and no lifetime history of treatment. The sample included respondents to the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a large population-based survey, who met criteria for a 12-month major depressive disorder (MDD) or dysthymia (DYS) and had no prior depression treatment. Bivariate and multivariate analyses were conducted examining which socio-demographic and clinical predictors among individuals with depressive disorders and no prior treatment at Wave 1 were associated with receiving depression treatment at Wave 2 (N = 337). Only 47.2% of those with MDD or DYS and no prior treatment at Wave 1 had received depression treatment at Wave 2. Females were more likely to have received treatment at Wave 2: those of Hispanic ethnicity, other race, unmarried, 12 years of education, self-rated health of good/very good/excellent and anxiety disorders were less likely to have received treatment at Wave 2. Those with substance use disorders were more likely to have received treatment at Wave 2. This study highlights individuals who would likely benefit from increased efforts to enhance depression treatment utilization.

Discrimination, Family Relationships, and Major Depression Among Asian Americans

Depression represents a growing concern among Asian Americans. This study examined whether discrimination and family dynamics are associated with depression in this population. Weighted logistic regressions using nationally representative data on Asian American adults (N = 2095) were used to examine associations between discrimination, negative interactions with relatives, family support, and 12-month major depressive disorder (MDD). Discrimination (odds ratio [OR] = 2.13, 95% confidence interval [CI] = 1.67, 2.71) and negative interactions with relatives (OR = 1.28, 95% CI = 1.03, 1.58) were positively associated with MDD. Family support was associated with lower MDD (OR = 0.73, 95% CI = 0.59, 0.89), and buffered lower levels of discrimination. Results suggest that discrimination may have negative mental health implications, and also point to the importance of family relationships for depression among Asian Americans. Findings suggest that providers may consider stress experienced at multiple ecological levels to address Asian American mental health needs.

Demographic correlates of DSM‐IV major depressive disorder among older African Americans, Black Caribbeans, and non‐Hispanic Whites: results from the National Survey of American Life

To examine the demographic correlates of lifetime and 12-month prevalence of major depressive disorder (MDD) among older African Americans, Black Caribbeans, and non-Hispanic Whites. Data are from adults aged 55 years and older (n = 1439) recruited to the National Survey of American Life (NSAL; 2001-2003). The Diagnostic and Statistical Manual Version IV World Mental Health Composite International Diagnostic Interview was used to assess the 12-month and lifetime MDD. Weighted logistic regression was used to model demographic correlates of MDD. The population prevalence of lifetime and 12-month MDD were 11.2% and 4.1%, respectively. Bivariate analyses revealed that younger respondents and those with greater disability had a higher prevalence of both lifetime and 12-month MDD compared with those who were older and who had lower disability. Multivariable logistic regressions controlling for demographic characteristics revealed that non-Hispanic Whites had the greatest odds of lifetime MDD (OR = 2.27, 95% CI = 1.32, 3.93). Women had significantly greater odds of lifetime MDD compared with men (OR = 2.49, 95% CI = 1.14, 5.41); there were no gender differences in 12-month MDD. Other significant predictors of MDD were marital status and region of residence. The distribution, correlates, and nature of associations with MDD vary as a function of whether we examined lifetime vs. 12-month MDD. Future work should account for within group differences among older adults with depression. Understanding MDD correlates and the nature of intergroup diversity can inform the identification of particularly vulnerable subgroups as well as appropriate treatment approaches.

Treatment disparities for major depressive disorder: Implications for pharmacists

ObjectivesTo determine whether differences exist in overall antidepressant use and specific antidepressant drug class (selective serotonin reuptake inhibitor [SSRI]/serotonin norepinephrine reuptake inhibitor [SNRI] versus other) use among patients of different race/ethnicity groups (blacks and Hispanics compared with whites) with a diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 12-month major depressive disorder (MDD) and to discuss ways in which pharmacists can decrease the gap in treatment disparities. DesignCross-sectional study. SettingUnited States from February 2001 through April 2003. ParticipantsRespondents of the National Comorbidity Survey–Replication with DSM-IV 12-month MDD. InterventionNot applicable. Main outcome measuresPrevious 12-month overall antidepressant use and previous 12-month specific antidepressant drug class (SSRI/SNRI versus other) use. ResultsFor respondents who screened positive for 12-month MDD (n = 362.3), only 34% reported antidepressant use in the previous 12-month period. Blacks (17.5%) and Hispanics (21.8%) reported significantly (P < 0.0001) lower overall use of antidepressants in the unadjusted analysis compared with whites (37.6%). Although not statistically significant, odds ratios (ORs) indicated that blacks and Hispanics were 61% and 47% less likely to report use of antidepressants (OR = 0.39 [95% CI 0.20–0.77], P = 0.10, and 0.53 [0.31–0.91], P = 0.61, respectively). ConclusionAmong respondents with a diagnosis of MDD, race/ethnicity plays an important role in the use of antidepressants. The results of this study indicate a need for pharmacists to proactively interact and manage their patients’ antidepressant therapy.

Drs. Nelson and Papakostas Reply

Drs. Nelson and Papakostas Reply

Comorbidity of Depressive and Anxiety Disorders for Older Americans in the National Comorbidity Survey-Replication

To identify age differences in the 12-month and lifetime comorbidity of depressive and anxiety disorders for adults (18-64 years) compared with older adults (65 years and older) in a nationally representative sample of community-dwelling adults in the United States. Cross-sectional epidemiologic study, using data from the National Comorbidity Survey-Replication public use dataset. Community-based epidemiologic survey. Representative national sample of community-dwelling adults in the United States. The World Health Organization Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders. More than half of respondents with a 12-month major depressive disorder (MDD) had a comorbid anxiety disorder or dysthymia (18-64 years = 60.6%; 65 years and older = 51.8%). High rates of MDD were also found for those with anxiety disorders across both age groups, highest in the 18-64 years group for generalized anxiety disorder (28.5%) and highest in the 65 years and older group for panic disorder (36.7%). Age group did not predict 12-month diagnosis of a comorbid anxiety disorder among those with a depressive disorder in multivariate logistic regression. Onset of anxiety disorders preceded onset of depressive disorders for most older adults (77.6%). Depressive and anxiety disorders frequently cooccurred in this representative sample of community-dwelling adults. Older adults experienced comorbidity to a similar extent as younger adults, suggesting high rates of comorbidity across the lifespan.

The prevalence and correlates of workplace depression in the national comorbidity survey replication.

To review evidence on the workplace prevalence and correlates of major depressive episodes, with a particular focus on the National Comorbidity Survey Replication, the most recent national survey to focus on these issues. Nationally representative survey of Diagnostic and Statistical Manual, 4th Revision Mental Disorders. A total of 6.4% of employed National Comorbidity Survey Replication respondents had 12-month major depressive disorder. An additional 1.1% had major depressive episodes due to bipolar disorder or mania-hypomania. Only about half of depressed workers received treatment. Fewer than half of treated workers received care consistent with published treatment guidelines. Depression disease management programs can have a positive return-on-investment from the employer perspective, but only when they are based on best practices. Given the generally low depression treatment quality documented here, treatment quality guarantees are needed before expanding workplace depression screening, outreach, and treatment programs.

Prevalence and Distribution of Major Depressive Disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites

Little is known about the relationship between race/ethnicity and depression among US blacks. 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. A slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview. 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. A total of 3570 African Americans, 1621 Caribbean blacks, and 891 non-Hispanic whites aged 18 years and older (N = 6082). 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. 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. 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.

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Objective: Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania. Method: The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders. Results: A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major depressive disorder with 27.2 lost workdays per ill worker per year. Subgroup analysis showed that the higher work loss associated with bipolar disorder than with major depressive disorder was due to more severe and persistent depressive episodes in those with bipolar disorder than in those with major depressive disorder rather than to stronger effects of mania/hypomania than depression. Conclusions: Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder. Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive disorder.

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania. The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders. A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major depressive disorder with 27.2 lost workdays per ill worker per year. Subgroup analysis showed that the higher work loss associated with bipolar disorder than with major depressive disorder was due to more severe and persistent depressive episodes in those with bipolar disorder than in those with major depressive disorder rather than to stronger effects of mania/hypomania than depression. Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder. Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive disorder.

Epidemiology of major depression in four cities in Mexico

Analyses were conducted to estimate lifetime and current prevalence of major depressive disorder (MDD) for four representative cities of Mexico, to identify variables that influence the probability of MDD, and to further describe depression in Mexican culture. A multistage probability sampling design was used to draw a sample of 2,509 adults in four different regions of Mexico. MDD was assessed according to DSM-IV criteria by using the Composite International Diagnostic Interview collected by trained lay interviewers. The prevalence of MDD in these four cities averaged 12.8% for lifetime and 6.1% for the previous 12 months. MDD was highly comorbid with other mental disorders. Women were more likely to have lifetime MDD than were men. Being divorced, separated, or widowed (compared to married or never married) and having experienced childhood trauma were related to higher lifetime prevalence but not to current prevalence. In addition, age and education level were related to current 12-month MDD. Data on the profile of MDD in urban Mexico are provided. This research expands our understanding of MDD across cultures.

Epidemiology of Major Depressive Disorder

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. Prevalence and associations of MDD with sociodemographic correlates and Axis I and II disorders. 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. 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.

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

Uncertainties exist about prevalence and correlates of major depressive disorder (MDD). 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). Face-to-face household survey conducted from February 2001 to December 2002. The 48 contiguous United States. Household residents ages 18 years or older (N = 9090) who responded to the NCS-R survey. 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. 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. 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.