Lifetime MDD Research Articles

The prevalence and impact of major depressive disorder among Chinese, Malays and Indians in an Asian multi-racial population

Reports of rates of depression among different Asian ethnic groups within the same country using standardized assessments are rare in the extant literature. This was a household survey of 6616 adult residents of Singapore which constituted a national representative sample. Face to face interviews were conducted with the English, Chinese and Malay versions of the World Mental Health Composite International Diagnostic Interview. The response rate was 75.9%. The lifetime and 12-month prevalence estimates for MDD were 5.8% and 2.2%, respectively. MDD was significantly higher among the females, Indians, those who were divorced/separated, or widowed. The median age of onset of MDD was 26 years with the highest risk of onset in those aged 18-34 years while the age group of 65 years and above had the lowest risk of onset. Chronic physical conditions were present in approximately half of the respondents with MDD. MDD was also associated with considerable disability in terms of days of role impairment. More than half (59.6%) of those with lifetime MDD had not ever sought professional help. This was a cross-sectional household survey that excluded those who were institutionalized. Responses were self-reported and therefore subjected to recall bias. Our findings add to the body of knowledge on the differential rates of depression among different ethnic groups; the association with disability, comorbid physical conditions and the considerable proportion of untreated cases also have important clinical and policy implications.

Exploring age of onset as a causal link between major depression and nonmedical use of prescription medications

Background Nonmedical use of prescription medications (NUPM) has been associated with major depression (MDD), but the specific processes by which they might interact and influence one another are understudied. This investigation attempted to clarify the relationship between MDD and NUPM by examining whether age of MDD onset influenced current and past NUPM and by examining whether age of NUPM onset influenced lifetime or past year MDD. Methods These goals were met through use of data from the 2005 to 2007 National Survey on Drug Use and Health. Analyses utilized design-based logistic regression, and current age and order of MDD onset and NUPM initiation were examined in interactions with age of MDD or NUPM onset. Results For each year MDD onset was delayed, odds of lifetime, past year, past 30-day NUPM and substance dependence from NUPM were decreased by 2.3%, 2.6%, 1.9% and 2.3%, respectively. Earlier NUPM onset increased odds of past year (3.8%) and lifetime MDD (4.3%) in young adults, and lifetime MDD (2.5%) in 26–34 age group. Current age also interacted with age of MDD onset, with effects on NUPM pronounced in the 65 and older cohort. Order of MDD/NUPM onset generally did not interact with age of MDD onset, but it did interact with age of NUPM onset; the effects of NUPM onset on past year MDD were only significant in those with NUPM first. Conclusions These results highlight the need for further investigations of the interactions between depression and NUPM, particularly to evaluate potential causal relationships.

Childhood adversity interacts separately with 5-HTTLPR and BDNF to predict lifetime depression diagnosis

The serotonin transporter polymorphism (5-HTTLPR) and the brain-derived neurotrophic factor (BDNF) val66met polymorphism have both been linked to depression symptoms and to depression diagnosis (MDD) in interaction with adversity; there have also been failures to find the effects. We reexamined both interactions for lifetime MDD in a college sample. Lifetime MDD was diagnosed by Structured Clinical Interview for DSM-IV in 133 undergraduates; genotypes for 5-HTTLPR and BDNF were assayed from blood, and self-reports were collected concerning childhood adversity (Risk). 5-HTTLPR interacted with Risk such that Risk predicted less likelihood of MDD among ll carriers and tended to predict greater likelihood of MDD among s carriers. BDNF interacted with Risk such that Risk predicted greater likelihood of MDD among met carriers and did not influence val/val carriers. These two interactions were additive: both were significant in a combined model.

Correlates of Psychological Distress and Major Depressive Disorder Among African American Men

This study examines the demographic correlates of depressive symptoms, serious psychological distress (SPD), and major depressive disorder (MDD; 12-month and lifetime prevalence) among a national sample of African American men. Analysis of the National Survey of American Life (NSAL) data set provides first-time substantiation of important demographic differences in depressive symptoms (measured by the Center for Epidemiological Studies Depression scale [CES-D]), SPD (measured by the K6), and 12-month and lifetime MDD among African American men. Findings illuminate the heterogeneity within the African American male population. Findings also demonstrate the need for additional research focusing on within-group differences and a comprehensive research and mental health promotion agenda that recognizes the importance of improving access to education and employment and promoting healthy coping behaviors, while acknowledging the larger social context in which African American men live.

The stability of parental bonding reports: A 20-year follow-up

BackgroundAddressing the long-term reliability of retrospectively assessed parenting is underscored by the well-documented association between parenting behaviors, and mood disorders in offspring. The rarity of longitudinal research with follow-up periods exceeding 10years creates a need for additional studies. Methods134 offspring of depressed and non-depressed parents were assessed on Parental Bonding Instrument (PBI) scores, lifetime major depression (MDD), and current depressive symptoms at four waves across 20years. PBI rank order and mean level stability, individual trajectories, and the impact of baseline age, gender, and lifetime MDD on stability, were obtained using multiple regression and linear mixed model analyses. ResultsBesides paternal overprotection which showed a 1.6-point average decrease, the PBI domains remained non-significant for mean level change over 20years. However, there was a significant individual variation for all PBI domains. Lifetime MDD and age did not significantly impact retest correlations; older age at baseline was associated with higher average paternal overprotection. Sons had lower retest correlations than daughters, but did not differ from daughters on mean level stability. Current depressive symptoms were associated with PBI scores, but did not impact the effect of lifetime MDD, gender or age on mean level stability and individual trajectories. LimitationsSmall sample sizes and measuring lifetime MDD as present or absent may have restricted our ability to detect effects of MDD history on PBI stability. ConclusionThe PBI is a robust measure of an important environmental risk for depressive disorders, and can be variably sensitive to sample characteristics, the passage of time and mood fluctuations. However, this sensitivity does not appear to significantly bias the long-term stability of this instrument.

Major depression and dimensional representations of DSM-IV personality disorders: a population-based twin study

Major depressive disorder (MDD) co-occurs frequently with personality disorders (PDs). The extent to which this results from shared genetic or environmental risk factors remains uncertain. Young adult twins (n=2801) from the population-based Norwegian Institute of Public Health Twin Panel were assessed at personal interview for DSM-IV lifetime MDD and the 10 Axis II PDs. The relationship between MDD and dimensional representations of all PDs was explored by stepwise logistic regression. Multivariate Cholesky twin models were fitted using the Mx program, and genetic and environmental correlations were estimated. Dimensional representations of borderline (BPD), avoidant (AVPD) and paranoid personality disorder (PPD) were independently and significantly associated with increased risk for MDD. Multivariate twin modeling indicated that one latent factor accounted for the genetic covariance between MDD and the three PDs. The genetic correlations between MDD and dimensional representations of BPD, AVPD and PPD were +0.56, +0.22 and +0.40 respectively. No sex differences or shared environmental effects were found. The structure of the individual-specific environmental factors influencing MDD and the three PDs were similar to the genetic factors but the environmental correlations were lower: +0.39, +0.23 and +0.27 respectively. There is substantial overlap between liability factors for MDD and BPD from cluster B, PPD from cluster A and AVPD from cluster C. The vulnerability to general PD pathology and MDD seem to be closely related. The patterns of co-morbidity observed between diverse psychiatric disorders might result from just a few liability factors.

Major depression in Kunming: Prevalence, correlates and co-morbidity in a south-western city of China

Background Kunming is a major city in south-western China. However, until recently, no epidemiological studies have been conducted to provide a profile of major depression in south-western China. Method A representative sample of the Kunming general population composed of 5033 individuals aged 15 years or older was interviewed from November 2005 to January 2006 using the World Health Organization Composite International Diagnostic Interview Version 2.1 (CIDI, version 2.1) for assessment. Results The weighted prevalence of major depression were 1.96% (lifetime), 1.09% (12-month) and 0.93% (30-day). The correlates for reported lifetime MDD include having higher educational level, living in urban districts, being unemployed, and being divorced/widowed/separated. Major depression was significantly comorbided with DSM-IV anxiety disorders and somatization. Conclusions The findings show a low prevalence rate of major depression in Kunming city. Close attention to public health approaches are required to address the relationships between social isolation, urban population, unemployed and high educational people. Resolving methodological problems may lead to more accurate prevalence estimates in future epidemiological studies.

Comorbidity of anxiety and depression

Epidemiological studies have shown that anxiety disorders and depressive disorders frequently co-occur. Comorbidity studies revealed that estimations on comorbidity patterns of anxiety disorder and depressive disorders differs widely (30-80%). These differences may be due to different sampling-frames (community sample; primary care sample; secondary care sample). Our data were derived from the first wave of the Netherlands Study on Depression and Anxiety (NESDA), a 10-year longitudinal study on the long term prognosis of anxiety and depression. In our sample, 1285 subjects (52%) had a Major Depressive Disorder and/or an anxiety disorder (GAD; Social Phobia, PD with or without agoraphobia; agoraphobia alone) measured with the CIDI. These subjects were recruited from the general population (9%), in primary care (46%) and in specialized mental health care (44%). Of the 870 subjects with a MDD in the previous 6-months, 60% had an anxiety disorder (6-months) and 71% had an life-time anxiety disorder. Of the 937 subjects with a PD, GAD, Social Phobia or Agoraphobia in the previous 6-months, 56% had a MDD (6-months) and 70% had an life-time MDD. As expected comorbidity between anxiety disorders and MDD were significantly higher for subjects recruited in specialized mental health care settings (50%), then for subjects recruited in primary health-care facilities (34%) and for subject recruited from general population (27%)(p<.001). These preliminary findings suggested high levels of comorbidity between MDD and anxiety disorder. Furthermore, our findings demonstrated higher comorbidity patterns for subjects in specialized mental health care-settings.

The role of estrogen and progesterone in depression after birth

Previous reports suggest that massive hormonal changes that accompany the peripartum period may trigger perinatal depression. We investigated the relationship between magnitude of change and total level of estrogen and progesterone and grade of peripartal depression and depressive symptoms. One hundred and ninety two women were assessed in the 38th week of pregnancy (SDS scores), peripartum period (DSM-III-R diagnosis ( n = 105); SDS scores) and 6 months postpartum (EPDS; n = 89) regarding diagnosis of depression, self-ratings of depressive symptoms and levels of estrogen and progesterone. The comparison of three diagnostic groups (lifetime major depressive disorder MDD ( N = 7), MDD at birth ( N = 12), healthy controls ( N = 70) showed that there were no differences in the magnitude of decline of estrogen and progesterone from day 1 to day 3 after birth . With respect to total levels of estrogen and progesterone, estrogen on day 3 was significantly higher [ F(2, 92) = 6.6, p < 0.05] in women with current MDD than in those with lifetime MDD or normal controls. Depression scores were significantly higher at the end of pregnancy (12.6% self-identified as depressed) than in postpartum period (5.8% day 3 p < .0004; 9.2% day 5 p < .008), whereas 13.3% of women received a DSM-III –R diagnosis for MDD 5 days postpartum. The results were in contrast to the current hypotheses of estrogen withdrawal or hypogonadal levels as an etiological factor for peripartum depression. But a limitation of the actual study is the low number of subjects with depression; therefore the current non-significant findings should be interpreted with great caution.

Psychiatric comorbidities in a community sample of women with fibromyalgia

Prior studies of careseeking fibromyalgia (FM) patients often report that they have an elevated risk of psychiatric disorders, but biased sampling may distort true risk. The current investigation utilizes state-of-the-art diagnostic procedures for both FM and psychiatric disorders to estimate prevalence rates of FM and the comorbidity of FM and specific psychiatric disorders in a diverse community sample of women. Participants were screened by telephone for FM and MDD, by randomly selecting telephone numbers from a list of households with women in the NY/NJ metropolitan area. Eligible women were invited to complete physical examinations for FM and clinician-administered psychiatric interviews. Data were weighted to adjust for sampling procedures and population demographics. The estimated overall prevalence of FM among women in the NY/NJ metropolitan area was 3.7% (95% CI = 3.2, 4.4), with higher rates among racial minorities. Although risk of current MDD was nearly 3-fold higher in community women with than without FM, the groups had similar risk of lifetime MDD. Risk of lifetime anxiety disorders, particularly obsessive compulsive disorder and post-traumatic stress disorder, was approximately 5-fold higher among women with FM. Overall, this study found a community prevalence for FM among women that replicates prior North American studies, and revealed that FM may be even more prevalent among racial minority women. These community-based data also indicate that the relationship between MDD and FM may be more complicated than previously thought, and call for an increased focus on anxiety disorders in FM.

Comorbid Major Depressive Disorder as a Prognostic Factor in Cocaine‐Abusing Buprenorphine‐Maintained Patients Treated with Desipramine and Contingency Management

Depression is common among patients who abuse both opiates and cocaine, and its treatment has had mixed success. This study compares buprenorphine‐maintained patients with lifetime major depressive disorder (MDD, N = 53) with those never depressed (ND, N = 96) on cocaine and opiate‐free urines during a 12‐week outpatient double‐blind, placebo‐controlled, randomized clinical trial. The 149 subjects were assigned to four groups: 1) desipramine (DMI) + contingency management (CM); 2) DMI + noncontingency management (NCM); 3) placebo + CM; and 4) placebo + NCM. Depression assessments included Hamilton Depression Rating Scale, Center for Epidemiological Studies Depression Inventory, and Structured Clinical Interview for DSM‐IV interview for diagnosis of lifetime MDD. Urine toxicologies were performed thrice weekly and the CES‐D was performed monthly. The MDD group had a larger proportion of females (45% vs 21%, P = 0.02) and were more likely to be married (13.2% vs 7.3%, P = 0.02) than the ND group. Treatment retention did not vary by depression status. Hierarchical Linear Modeling found that depressive symptoms decreased comparably across the four treatment groups. Although participation in CM improved drug‐free urines more for patients with MDD than for the ND group (Z = 2.44, P = 0.01), treatment with DMI was significantly more efficacious for the ND group than for the MDD group (Z = −2.89, P = 0.003). These results suggest that patients with MDD may respond better to behavioral treatments such as CM than to desipramine plus buprenorphine. The ND cocaine‐abusing, opiate‐dependent patients may be more responsive to the anticraving effects of DMI.