12-month Major Depressive Episode Research Articles

Differences in mental health problems in LGBT+ first year college students in Chile during the pandemic

PurposeTo examine the differences in mental health problems by sexual orientation and gender identity in first-year university students in Chile during the pandemic. Methods: 7,213 first-year students aged 18 years and older from five universities participated as part of the World Mental Health - International College Student initiative in Chile. Students completed an online self-report survey between 2020 and 2021 that included measures of lifetime and 12-month major depressive episode, generalized anxiety disorder, panic disorder, bipolar disorder, drug abuse/dependence, alcohol dependence, non-suicidal self-injuries, and suicidal risk. Prevalence of mental health problems were estimated and the differences by sexual orientation and gender identity were examined using logistic and multinomial logistic regression models. Results: Between 84.1% and 98% of lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) students screened positive for at least one lifetime mental health problem and between 67.6% and 90.6% for two or more problems. For most outcomes, non-heterosexual (Odds Ratio [OR] between 1.25 and 7.00) and trans and gender nonconforming students (OR between 1.72 and 5.81) had significantly higher odds of positive screening for lifetime mental health problems than heterosexual and cisgender students, respectively. Similar results were observed for 12-month mental health problems. Conclusion: The results show differences in the prevalence of mental health problems in LGBT+ university students in Chile, which are consistent with those found in other countries. These results may be useful for planning interventions to improve the mental health of LGBT+ students.

Prevalence, time trends, and correlates of major depressive episode and other psychiatric conditions among young people amid major social unrest and COVID-19 in Hong Kong: a representative epidemiological study from 2019 to 2022

Hong Kong is among the many populations that has experienced the combined impacts of social unrest and the COVID-19 pandemic. Despite concerns about further deteriorations in youth mental health globally, few epidemiological studies have been conducted to examine the prevalence and correlates of major depressive episode (MDE) and other major psychiatric disorders across periods of population-level changes using diagnostic interviews. We conducted a territory-wide household-based epidemiological study from 2019 to 2022 targeting young people aged 15-24 years. MDE, generalised anxiety disorder (GAD), panic disorder (PD), and bipolar disorder (BD) were assessed using the Composite International Diagnostic Interview-Screening Scales in 3340 young people. Psychotic disorders were assessed by experienced psychiatrists according to the DSM. Help-seeking patterns were also explored. 16.6% had any mental disorder (13.7% 12-month MDE, 2.3% BD, 2.1% GAD, 1.0% PD, 0.6% psychotic disorder). The prevalence of MDE increased from 13.2% during period 1 (May 2019-June 2020) to 18.1% during period 2 (July-December 2020), followed by 14.0% during period 3 (January-June 2021) and 13.2% during period 4 (July 2021-June 2022). Different stressors uniquely contributed to MDE across periods: social unrest-related stressors during period 1, COVID-19 stressors during period 2, and personal stressors during periods 3-4. Lower resilience, loneliness, frequent nightmares, and childhood adversity were consistently associated with MDE. Compared to other conditions, those with MDE showed the lowest service utilisation rate (16.7%). Perceiving services to "cost too much" and "talked to friends or relatives instead" were among the major reasons for not seeking help. MDE was also significantly associated with poorer functioning and health-related quality of life. MDE can be sensitive to population-level changes, although its persistently elevated prevalence across the study period is of concern. Efforts to mitigate their impacts on youth mental health alongside personal risk factors are needed. Further work is required to increase the availability and acceptability of youth-targeted mental health services. Food and Health Bureau (HKSAR Government).

Sex differences in the symptom network structure of depression: Findings from a nationwide sample of the Spanish adult population

BackgroundSex differences in the prevalence and clinical features of depression have been widely described. However, some authors argue that categorical diagnostic systems do not adequately capture the complexity of depression. The aim of this study was to examine sex differences in the symptom network structure of depressive symptoms among individuals with a major depressive episode. MethodsThe study sample consisted of 510 participants (age 62.17 ± 14.43, 71.96 % women) from a nationwide study of the Spanish non-institutionalised adult population (Edad con Salud). To estimate the presence of a 12-month major depressive episode according to DSM-IV criteria, participants were administered an adapted version of the Composite International Diagnostic Interview (CIDI 3.0). A network analysis was carried out to determine possible interrelationships between different depressive symptoms by sex. ResultsMen and women showed a similar overall structure and network strength. However, sex-specific variations emerged in relation to individual symptom associations and symptom centrality. Specifically, for individual symptom associations “loss of confidence” and “suicide attempts” were more strongly related in women, and “suicidal ideation” and “impaired thinking” in men. For symptom centrality, “anxiety” played a central role in men's symptomatology, whereas “hopelessness”, “loss of confidence”, “distress” and “slowness of movement” were the most central symptoms in the women's group. LimitationsReliance on cross-sectional data precludes us from determining the direction and temporality of the association between different symptoms. ConclusionsThis study suggests that specific symptoms should be prioritised in the prevention, diagnosis assessment and treatment of depressed patients based on sex.

Major depression with co-occurring suicidal thoughts, plans, and attempts: An increasing mental health crisis in US adolescents, 2011–2020

This study aimed to examine national trends and disparities in the prevalence and treatment of adolescent 12-month major depressive episode (MDE) with co-occurring suicidal thoughts, plans, and attempts. Publicly available data for adolescents aged 12–17 in the 2011–2020 National Survey on Drug Use and Health were analyzed. Bivariate and multivariable logistic regression analyses were conducted. In 2011, 4.6%, 2.1%, and 1.7% of adolescents had 12-month MDE with co-occurring suicidal thoughts, plans, and attempts, and the prevalence increased steadily to 9.8%, 5.3%, and 3.5% in 2019, respectively. In 2011, 45% of adolescents with MDE and suicidal thoughts received any mental health treatment, and the prevalence increased slightly to 46.6% in 2019. Meanwhile, the prevalence of treatment use among adolescents with MDE and suicidal plans remained stable at below 54%. Lastly, the prevalence of treatment use increased significantly from 53.6% in 2011 to 60.8% in 2019 among those with MDE and suicidal attempts. Continued high prevalence and low treatment use were observed in 2020. Disparities in treatment use were found in older adolescents, adolescents without insurance, Hispanics, and Asians. Concerted efforts are needed to prioritize evidence-based interventions, enhance outreach to high-risk groups, and expand service provisions to underserved adolescents.

Mental health in medical, dental and pharmacist students: a cross-sectional study

IntroductionHealth student’s mental health is considered a public health issue that dramatically increased with COVID 19’s pandemic. However, very few studies assessed the prevalence of mental health in medical, pharmacist, and dental students.ObjectivesOur goal was to assess mental health in health students from the same university one year after pandemic’s beginning and look at for associated factors.MethodsAn online survey was realized in Paris university which has the 3 specialties (medicine, pharmacy, and dental). We used the Hospitalization Anxiety and Depression scale, Composite International Diagnostic Interview - Short Form questionnaire, Maslach Burnout Inventory (with 2 versions (Student survey and Human Services Survey). We also asked for 12 months of suicidal ideation, humiliation, sexual harassment, and sexual aggression. We did multivariable logistic regression analyses to identify Major Depressive Episode (MDE) associated factors.ResultsWe included 1925 students: 95 dental, 233 pharmacists, 541 medical preclinic, 587 medical clinic and 469 residents. Overall prevalence of 7- days anxiety symptoms, 7- days depressive symptoms, 12-month MDE, 12-month suicidal ideation, humiliation, sexual harassment and sexual aggression were 55%, 23%, 26%, 19%, 19%, 22% and 6% respectively. There were significative differences between groups for anxiety and depressive symptoms and MDE (p<0.001 for all). Associated factors to MDE in multivariable logistic regression were humiliation (OR=1.71, IC95[1.28-2.28]), sexual harassment (OR=1.60, IC95[1.19-2.16]), sexual abuse (OR=1.65, IC95[1.04-2.60])) and moderate (OR=1.49, IC95[1.17-1.90]) or important (OR=2.32, IC95[1.68-3.20]) subjective financial difficulties.ConclusionsHealth student’s prevalence of psychiatric symptoms is significant, but it seems possible to intervene on several risk factors.DisclosureNo significant relationships.

Predictive models for first-onset and persistence of depression and anxiety among university students

BackgroundDepression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions. MethodsMulticenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up. ResultsA total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline. LimitationsSelf-report data were used; external validation of the multivariable prediction models is needed. ConclusionMDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.

Mental health and working conditions among French medical students: A nationwide study

BackgroundMedical students' mental health is a public health problem that has worsened with COVID 19's pandemic. There is a lack of French data. The principal aim was to assess French medical students' mental health. MethodsAn online cross-sectional survey was performed between May 27 and June 27, 2021. An anonymous questionnaire was sent via academic email addresses by medical faculties and secondly on social media. We assessed 7-day anxiety and depressive symptoms were evaluated with the Hospitalization Anxiety and Depression scale, 12-month major depressive episode (MDE) with the Composite International Diagnostic Interview- Short Form, burnout with the Maslach Burnout Inventory, 12-month suicidal ideation, humiliation, sexual harassment, and sexual aggression during their curriculum. Multivariable logistic regression was performed to identify main MDE associated factors. Outcomes11,754 participants (response rate: 15.3%) were included. Prevalence of 7-day anxiety symptoms, 7-day depressive symptoms, 12-month MDE, and 12-month suicidal thoughts were 52%, 18%, 25%, and 19% respectively. Burnout syndrome concerned 67% of clinical students and residents and 39% of preclinical students. Prevalence of humiliation, sexual harassment, and sexual abuse during their curriculum were 23%, 25%, and 4%, respectively. Having important (OR = 1.44, IC 95 [1.31–1.58], p < 0.001) or very important financial issues (OR = 2.47, IC 95 [2.15–2.85], p < 0.001), experienced humiliation (OR = 1.63, IC 95 [1.46–1.81], p < 0.001), sexual harassment (OR = 1.43, IC 95 [1.28–1.59], p < 0.001) and sexual abuse (OR = 1.52, IC 95 [1.24–1.85], p < 0.001) were associated with an increased risk of MDE. InterpretationThis is the largest study on French medical students' mental health. These results point to very particular conditions in French students environment that need to be addressed to improve their mental health.

The effect of loneliness and social support on the course of major depressive disorder among adults aged 50 years and older: A longitudinal study.

Previous research indicates that social support, loneliness, and major depressive disorder (MDD) are interrelated. Little is known about the potential pathways among these factors, in particular in the case of adults aged 50 years and older and suffering from MDD. The objective was to investigate whether loneliness mediates the association between low social support and recurrent episodes of MDD. We used data from a cohort of the Spanish general population interviewed at three time-points over a 7-year period. We included 404 individuals aged 50+ suffering from MDD in the baseline assessment. A 12-month major depressive episode was assessed with the Composite International Diagnostic Interview (CIDI) at each interview. The University of California, Los Angeles Loneliness Scale was used to measure loneliness, whereas social support was assessed through the Oslo Social Support Scale. We tested cross-lagged and autoregressive longitudinal associations using structural equation modeling. We identified two significant longitudinal mediation patterns: lower social support predicted higher subsequent levels of loneliness (Coef. = -0.16; p < .05), which in turn predicted an increase in MDD recurrence (Coef. = 0.05; p < .05). Interventions focused on promoting social support among older adults suffering from MDD may decrease feelings of loneliness and prevent recurrent episodes of MDD.

Association of Child Maltreatment and Deployment-related Traumatic Experiences with Mental Disorders in Active Duty Service Members and Veterans of the Canadian Armed Forces: Association de la Maltraitance des Enfants et des Expériences Traumatisantes Liées au Déploiement Avec les Troubles Mentaux Chez les Membres du Service Actif et Les Anciens Combattants des Forces Armées Canadiennes.

Objective:Mental health among military personnel is an important public health priority. It is known that military personnel experience a high prevalence of child maltreatment and deployment-related traumatic events (DRTEs) and both are related to mental health outcomes. However, few, if any, studies have examined the cumulative and interactive effects of child maltreatment and DRTEs on mental health disorders in a sample of active duty service members and military veterans.Methods:Data were from the Canadian Armed Forces (CAF) Members and Veterans Mental Health Follow-up Survey collected in 2018 (N = 2,941, response rate = 68.7%), a 16-year follow-up survey of CAF Regular Force members interviewed in 2002. Five types of child maltreatment and 10 types of DTREs were assessed for impact on mental health. Mental disorders included past 12-month generalized anxiety disorder (GAD), panic disorder, social phobia, and major depressive episode (MDE). Past 12-month symptoms of posttraumatic stress disorder (PTSD) were also examined.Results:The prevalence of any exposure to child maltreatment and DRTEs was 62.5% and 68.6%, respectively. All types of child maltreatment were associated with increased odds of past 12-month PTSD symptoms and mental disorders with the exception of physical abuse and GAD as well as childhood exposure to intimate partner violence and panic disorder. Cumulative effects of having experienced both child maltreatment and DRTEs increased the odds of past 12-month PTSD symptoms, GAD, social phobia, and MDE. No interaction effects were significant.Conclusions:The prevalence of a child maltreatment history is high among active Canadian military and veterans. As well, child maltreatment may increase the likelihood of mental disorders across the life span. This may be especially true for individuals who also experience DRTEs. Understanding these relationships may provide insight into developing effective interventions for military personnel and veteran mental health outcomes.

Effects of transient and chronic loneliness on major depression in older adults: A longitudinal study.

The number of older adults is rapidly rising globally. Loneliness is a common problem that can deteriorate health. The aims of this work were to identify different types of loneliness (transient and chronic) and to assess their association with depression over time. A nationally representative sample from the Spanish population comprising 1190 individuals aged 50+ years was interviewed on three evaluations over a 7-year period. The UCLA Loneliness Scale was used to measure loneliness. While chronic loneliness was defined as the presence of loneliness across all three waves, transient loneliness expressed the presence of loneliness in one wave only. A 12-month major depressive episode was assessed at each interview. After confirming the cross-sectional relationship, a multilevel mixed-effects model was used to examine the association between loneliness and depression. Almost a quarter of individuals felt lonely and one out of 10 presented depression at baseline. Of the sample, 22.78% showed transient loneliness, while 6.72% presented the chronic type. People experiencing chronic loneliness were at a higher risk of presenting major depression (OR = 6.11; 95% CI = 2.62, 14.22) than those presenting transient loneliness (OR = 2.22; 95% CI = 1.19, 4.14). This association varied over time and was stronger at the first follow-up than at the second one. Focusing on loneliness prevention could reduce the risk of depression. Chronic loneliness is a public health problem that should be addressed through the full participation of the political, social, and medical sectors.

Prevalence of 12-month mental and substance use disorders in sexual minority college students in Mexico.

Mental health disparities have been documented among sexual minority college students, but there is a dearth of evidence from developing countries. The aim is to estimate the prevalence of 12-month mental and substance use disorders across a range of sexual identities among first-year college students in Mexican universities, and test whether there is an association between sexual identity and disorders and whether the association is moderated by gender. The University Project for Healthy Students, a web-based survey conducted as part of the World Health Organization's World Mental Health International College Student initiative, recruited 7874 students from nine Mexican universities in 2016 and 2017. Logistic regressions estimated the association of sexual identity with 12-month major depressive episode, generalized anxiety disorder, panic disorder, alcohol abuse/dependence, and drug abuse/dependence, with interaction terms for gender. Compared to heterosexual students reporting no same-sex attraction (SSA), heterosexual students with SSA (AORs range 1.77-3.67) and lesbian/gay and bisexual students (AORs range 2.22-5.32) were at a higher risk for several disorders. Asexual students were at higher risk for drug abuse/dependence (AOR = 3.64). Students unsure of their sexual identity were at a higher risk for major depressive episode, panic disorder, and drug abuse/dependence (AORs range 2.25-3.82). Gender differences varied across sexual identity and disorder. These findings are the first empirical report of sexual minority psychiatric disparities among a college student population from a developing nation and underscore the importance of clinical interventions that address mental health needs among sexual minority college students.

Race, Depression, and Financial Distress in a Nationally Representative Sample of American Adults.

Background: Although depression and financial distress are correlated, this association may differ for demographic groups, particularly based on race. Aim: Using a national sample of American adults, this study tested whether the association between Major Depressive Episode (MDE) and financial distress differs between African Americans and Whites. Methods: The National Survey of American Life (NSAL), 2003, enrolled 3570 African American and 891 Non-Hispanic White American adults. Demographic data (age and gender), socioeconomic position (SEP; i.e., education, employment, marital status, and income), financial distress, and 12-month MDE were measured. Logistic regression was used for data analysis. Results: In the pooled sample, 12-month MDE was associated with higher odds of financial distress, above and beyond objective SEP measures. We found MDE by race interaction on financial distress, suggesting stronger association between MDE and financial distress among African Americans, compared to Whites. Conclusions: The link between MDE and financial distress depends on race. The financial needs of African Americans with depression should be addressed. Depression screening is also needed for African Americans with financial distress.

Does Discrimination Explain High Risk of Depression among High-Income African American Men?

Background: Higher socioeconomic status is known to decrease the risk for poor mental health overall. However, African American males of higher socioeconomic status (SES) are at an increased risk for having a major depressive episode (MDE). It is not known whether perceived discrimination (PD) explains this risk. The current study used nationally representative data to explore the role of PD in explaining the association between high-SES and having MDE among African American men. Methods: The National Survey of American Life (NSAL), 2003, included 4461 American adults including 1271 African American men. SES indicators (i.e., household income, educational attainment, employment status, and marital status) were the independent variables. 12-month MDE measured using the Composite International Diagnostic Interview (CIDI) was the outcome. Age, gender, and region were the covariates. PD was the potential mediator. For data analysis, we used logistic regression. Results: Among African American men, household income was positively associated with odds of 12-month MDE. The positive association between household income and odds of MDE remained unchanged after adding PD to the model, suggesting that PD may not explain why high-income African American men are at a higher risk of MDE. Conclusions: Perceived discrimination does not explain the increased risk for depression among African American males of higher SES. Future research should explore the role of other potential mechanisms such as stress, coping, social isolation, and/or negative social interaction that may increase psychological costs of upward social mobility for African American males.

Social Determinants of Depression: The Intersections of Race, Gender, and Socioeconomic Status.

Background: Despite the wealth of literature on social determinants of mental health, less is known about the intersection of these determinants. Using a nationally representative sample, this study aimed to study separate, additive, and multiplicative effects of race, gender, and SES on the risk of major depressive episode (MDE) among American adults. Methods: National Survey of American Life (NSAL) included 3570 African Americans and 891 Whites. Race, gender, socioeconomic status (SES, household income, education, employment, and marital status) were independent variables. Twelve-month MDE was measured by the Composite International Diagnostic Interview (CIDI). A series of logistic regressions were used to analyze the data. Results: In the pooled sample, race and household income, but not gender, education, employment, and marital status were associated with 12-month MDE. Gender interacted with the effects of income on MDE, suggesting that the association between household income and MDE is larger for women than men. In race by gender specific models that controlled for other SES indicators, high income was protective for White women, education was protective for African American women, and high income became a risk factor for African American men. High income did not show a risk effect for African American men in the absence of other SES indicators. Conclusions: Findings suggest that race, gender, and class interact on how SES indicators, such as education or income, become a protective or a risk factor for MDE among American Adults. When the outcome is MDE, White women benefit more from income, African American women gain from education, however, the residual effect of high income (above and beyond education, employment, and marital status) may become a risk factor for African American men.

Depression in Lesbian, Gay, and Bisexual Members of the Canadian Armed Forces.

Lesbians, gay men, and bisexuals have been shown to have different risks for mood and anxiety disorders than heterosexuals in population studies, but there is a paucity of research in this area in military populations. This study examined the relationship between sexual orientation and depression in the Canadian Armed Forces (CAF). Data were drawn from the Canadian Forces Mental Health Survey 2013 (n = 8165), a representative sample of Regular and Reserve members of the Canadian military. Binomial logistic regression was used to predict 12-month and lifetime odds ratios for major depressive episode (MDE) stratified by sexual orientation and sex. Gay male members had higher risk (AOR = 3.80, 95% CI 1.60-9.05) for lifetime MDE, but not for past 12-month MDE compared to heterosexual males. There was no significant difference in risk for lesbians or bisexuals compared to heterosexuals. The results suggest that gay male members of the CAF are at higher risk for a history of MDE, but not current MDE. This may be a result of ongoing discrimination and stigma faced by gay men in the military or may reflect MDE that occurred before military service. The lack of difference in MDE risk for lesbian and bisexual members compared to heterosexual members is an important positive finding.

Ethnic Variation in the Cross-sectional Association between Domains of Depressive Symptoms and Clinical Depression.

The degree by which depressive symptoms and clinical depression reflect each other may vary across populations. The present study compared Blacks and Whites for the magnitude of the cross-sectional associations between various domains of depressive symptoms and endorsement of clinical disorders of depression. Data came from the National Survey of American Life, 2001-2003. We included 3570 Black (African-Americans) and 891 Non-Hispanic Whites. Predictors were positive affect, negative affect, and interpersonal problems measured using the 12-item Center for Epidemiologic Studies Depression Scale (CES-D). Outcomes were lifetime major depressive disorder (MDD), lifetime major depressive episode (MDE), 12-month MDE, 30-day MDE, and 30-day major depressive disorder with hierarchy (MDDH) based on the Composite International Diagnostic Interview (CIDI). Logistic regression models were applied in the pooled sample as well as Blacks and Whites. Regarding CES-D, Blacks had lower total scores, positive affect, negative affect, and interpersonal problems compared to Whites (p < 0.05 for all comparisons). Blacks also had lower odds of meeting criteria for lifetime MDD and MDE, 12-month MDE, and 30-day MDE and MDDH (p < 0.05 for all comparisons). For most depressive diagnoses, ethnicity showed a positive and significant interaction with the negative affect and interpersonal problems domains, suggesting stronger associations for Blacks compared to Whites. The CES-D total score and CES-D positive affect domain did not interact with ethnicity on CIDI-based depressive diagnoses. Stronger associations between multiple domains of depressive symptoms and clinical depression may be due to higher severity of depression among Blacks, when they endorse the CIDI criteria for the disorder. This finding may explain some of previously observed ethnic differences in social, psychological, and medical correlates of depressive symptoms and clinical depression in the general population as well as clinical settings.

Association Between Stressful Life Events and Depression; Intersection of Race and Gender.

Although stressful life events (SLEs) and depression are associated, we do not know if the intersection of race and gender modifies the magnitude of this link. Using a nationally representative sample of adults in the USA, we tested if the association between SLE and major depressive episode (MDE) depends on the intersection of race and gender. Data came from the National Survey of American Life (NSAL), 2003, a cross-sectional survey that enrolled 5899 adults including 5008 Blacks (African-Americans or Caribbean Blacks), and 891 Non-Hispanic Whites. Logistic regression was used for data analysis. Stressful life events (past 30days) was the independent variable, 12-month MDE was the dependent variable, and age, educational level, marital status, employment, and region of country were controls. In the pooled sample, SLE was associated with MDE above and beyond all covariates, without the SLE × race interaction term being significant. Among men, the SLE × race interaction was significant, suggesting a stronger association between SLE and MDE among White men compared to Black men. Such interaction between SLE × race could not be found among women. The association between SLE and depression may be stronger for White men than Black men; however, this link does not differ between White and Black women. More research is needed to better understand the mechanism behind race by gender variation in the stress-depression link.

The Epidemiology of Major Depressive Episode in the Iraqi General Population.

ObjectiveTo assess the prevalence, symptom severity, functional impairment, and treatment of major depressive episode (MDE) in the Iraqi general population.MethodsThe Iraq Mental Health Survey is a nationally representative face-to-face survey of 4,332 non-institutionalized adults aged 18+ interviewed in 2006–2007 as part of the WHO World Mental Health Surveys. Prevalence and correlates of DSM-IV MDE were determined with the WHO Composite International Diagnostic Interview (CIDI).FindingsLifetime and 12-month prevalence of MDE were 7.4% and 4.0%, respectively. Close to half (46%) of the 12-month MDE cases were severe/very severe. MDE was more common among women and those previously married. Median age of onset was 25.2. Only one-seventh of 12-month MDE cases received treatment despite being associated with very substantial role impairment (on average 70 days out of role in the past year).ConclusionsMDE is a commonly occurring disorder in the Iraqi general population and is associated with considerable disability and low treatment. Efforts are needed to decrease the barriers to treatment and to educate general medical providers in Iraq about the recognition and treatment of depression.

Differences in patients’ perceived helpfulness of depression treatment provided by general medical providers and specialty mental health providers

ObjectiveThis study examined the differences in the level of perceived helpfulness of treatments received for a major depressive episode (MDE) from a general medical provider only, a specialty mental health provider only or both. MethodThis study examined a sample of 8900 respondents from the 2008–2012 National Survey on Drug Use and Health aged 18–64 who had past 12-month MDE (based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition) and received treatment for depression. Generalized ordered logistic regression analyses were conducted to estimate the association between the type of treatment providers and perceived helpfulness of depression treatment. ResultsAdults who received depression treatment from either specialty mental health providers alone or from both specialty mental health providers and general medical providers in the past year were more likely to report that treatment helped them. The differences persisted after adjusting for sociodemographic characteristics, comorbid health conditions, receipt of depression medication and severity of depression (adjusted odds ratios across level of perceived helpfulness ranged from 1.63 to 3.96). ConclusionsThis finding calls for greater attention to factors associated with provider type and organizational context that may contribute to differences in perceived helpfulness of depression treatment.

Major depression in China-to-US immigrants and US-born Chinese Americans: Testing a hypothesis from culture–gene co-evolutionary theory of mental disorders

BackgroundIn this study, the culture–gene co-evolutionary theory of mental disorders was used to test the hypothesis that major depression was less prevalent in China-to-US immigrants who migrated to the US as adults than in US-born adult Chinese Americans. MethodsData from the Collaborative Psychiatric Epidemiology Surveys (CPES) were extracted for secondary data analyses on the rates of major depression disorder (MDD) and major depressive episode (MDE) in the two groups. ResultsFindings showed that for life time MDD, the rates for China-to-US immigrant and US-born Chinese were 5.3% and 7.9% for men and 8.5% and 33.1% for women. For 12-month MDD, the corresponding rates were 2.2% and 3.4% for men, and 4.7% and 12.6% for women. For life time MDE, the corresponding rates were 6.8% and 8.8% for men; for women the rates were 8.5% and 33.1%. For 12-month MDE, the rates were 2.2% and 4.4% for men; the rates were 4.7% and 12.6% for women. Controlling for age, education level, income, BMI, marital status, and income-to-needs ratio, China-to-US immigrant women remained less likely to have life time major depression than US-born Chinese American women. LimitationsWhile the study has the strength of utilizing nationally representative datasets, the approach is limited as the data sources lack the capacity to investigate how the strength of connection with the collectivist culture might be related to major depression in the immigrant group.