ContextUncertainties exist about prevalence and correlates of major depressive
disorder (MDD).ObjectiveTo 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).DesignFace-to-face household survey conducted from February 2001 to December
2002.SettingThe 48 contiguous United States.ParticipantsHousehold residents ages 18 years or older (N = 9090) who responded
to the NCS-R survey.Main Outcome MeasuresPrevalence 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.ResultsThe 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.ConclusionsMajor 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.

/pdf/the-epidemiology-of-major-depressive-disorder-results-from-2kfxdgis3p.pdf

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

This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection.

/pdf/the-world-mental-health-wmh-survey-initiative-version-of-the-2n6nicodkz.pdf

The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).

Objective: Despite growing interest in adult attention deficit hyperactivity disorder (ADHD), little is known about its prevalence or correlates. Method: A screen for adult ADHD was included in a probability subsample (N=3,199) of 18–44-year-old respondents in the National Comorbidity Survey Replication, a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 respondents, oversampling those with positive screen results. Multiple imputation was used to estimate prevalence and correlates of clinician-assessed adult ADHD. Results: The estimated prevalence of current adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the survey and was associated with substantial role impairment. The majority of cases were u...

/pdf/the-prevalence-and-correlates-of-adult-adhd-in-the-united-5fbxyszdr6.pdf

The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.

This paper introduces and applies an operationalization of mental health as a syndrome of symptoms of positive feelings and positive functioning in life. Dimensions and scales of subjective well-being are reviewed and conceived of as mental health symptoms. A diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, is applied to data from the 1995 Midlife in the United States study of adults between the ages of 25 and 74 (n = 3,032). Findings revealed that 17.2 percent fit the criteria for flourishing, 56.6 percent were moderately mentally healthy, 12.1 percent of adults fit the criteria for languishing, and 14.1 percent fit the criteria for DSM-III-R major depressive episode (12-month), of which 9.4 percent were not languishing and 4.7 percent were also languishing. The risk of a major depressive episode was two times more likely among languishing than moderately mentally healthy adults, and nearly six times greater among languishing than flourishing adults. Multivariate analyses revealed that languishing and depression were associated with significant psychosocial impairment in terms of perceived emotional health, limitations of activities of daily living, and workdays lost or cutback. Flourishing and moderate mental health were associated with superior profiles of psychosocial functioning. The descriptive epidemiology revealed that males, older adults, more educated individuals, and married adults were more likely to be mentally healthy. Implications for the conception of mental health and the treatment and prevention of mental illness are discussed.

The mental health continuum: from languishing to flourishing in life.

Anxiety is as common as depression; however, it has received less attention and is often undetected and undertreated. The authors administered a 7-item anxiety scale to 965 primary care patients, w...

Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection

The estimated lifetime prevalence of bipolar disorder (BPD) in population surveys using structured diagnostic interviews and standardized criteria averages approximately 0.8% for BP-I and 1.1% for BP-II.1-8 Despite this comparatively low prevalence, BPD is a leading cause of premature mortality due to suicide and associated medical conditions such as diabetes and cardiovascular disease.9, 10 BPD also causes widespread role impairment.11, 12 The recurrent nature of manic and depressive episodes often leads to high direct as well as high indirect health care costs.13, 14

BPD might be even more burdensome from a societal perspective due to the fact that sub-threshold bipolar spectrum disorder has seldom been taken into consideration in examining the epidemiology of BPD. Bipolar spectrum disorder includes hypomania without major depression and hypomania of lesser severity or briefer duration than specified in the DSM and ICD criteria. Although the precise definitions are as yet unclear, recent studies suggest that bipolar spectrum disorder might affect as many as 6% of the general population.15, 16 However, bipolar spectrum disorder has not been studied previously in a nationally representative survey of the US. The purpose of the current report is to present the results of such a study based on analysis of the National Comorbidity Survey Replication (NCS-R).17 We estimate prevalence and clinical features of sub-threshold BPD in comparison to BP-I and BP-II.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/482285/yoa60082_543_552.pdf

Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication

BACKGROUND: The economic burden of depression was estimated to be 43.7 billion dollars in 1990. A subsequent study reported a cost burden of 52.9 billion dollars using revised prevalence data and a refined workplace cost estimation approach. The objective of the current report is to provide a 10-year update of these estimates using the same methodological framework. METHOD: Using a human capital approach, we developed prevalence-based estimates of 3 major cost categories: (1) direct costs, (2) mortality costs arising from depression-related suicides, and (3) costs associated with depression in the workplace. Cost-of-illness estimates from 1990 were updated to reflect the experience in 2000 using current epidemiologic data and publicly available population, wage, and cost information. RESULTS: Whereas the treatment rate of depression increased by over 50%, its economic burden rose by only 7%, going from 77.4 billion dollars in 1990 (inflation-adjusted dollars) to 83.1 billion dollars in 2000. Of the 2000 total, 26.1 billion dollars (31%) were direct medical costs, 5.4 billion dollars (7%) were suicide-related mortality costs, and 51.5 billion dollars (62%) were workplace costs. CONCLUSION: The economic burden of depression remained relatively stable between 1990 and 2000, despite a dramatic increase in the proportion of depression sufferers who received treatment. Future research will incorporate additional costs associated with depression sufferers, including the excess costs of their coexisting psychiatric and medical conditions and attention to the role of painful conditions as a driver of these costs. Language: en

The economic burden of depression in the United States: how did it change between 1990 and 2000?

BACKGROUND: The economic burden of depression in the United States-including major depressive disorder (MDD), bipolar disorder, and dysthymia-was estimated at $831 billion in 2000 We update these findings using recent data, focusing on MDD alone and accounting for comorbid physical and psychiatric disorders METHOD: Using national survey (DSM-IV criteria) and administrative claims data (ICD-9 codes), we estimate the incremental economic burden of individuals with MDD as well as the share of these costs attributable to MDD, with attention to any changes that occurred between 2005 and 2010 RESULTS: The incremental economic burden of individuals with MDD increased by 215% (from $1732 billion to $2105 billion, inflation-adjusted dollars) The composition of these costs remained stable, with approximately 45% attributable to direct costs, 5% to suicide-related costs, and 50% to workplace costs Only 38% of the total costs were due to MDD itself as opposed to comorbid conditions CONCLUSIONS: Comorbid conditions account for the largest portion of the growing economic burden of MDD Future research should analyze further these comorbidities as well as the relative importance of factors contributing to that growing burden These include population growth, increase in MDD prevalence, increase in treatment cost per individual with MDD, changes in employment and treatment rates, as well as changes in the composition and quality of MDD treatment services Language: en

https://www.psychiatrist.com/read-pdf/5356

The economic burden of adults with major depressive disorder in the United States (2005 and 2010).

Background We assess the annual economic burden of anxiety disorders in the United States from a societal perspective. Method Using data from the National Comorbidity Study, we applied multivariate regression techniques to calculate the costs associated with anxiety disorders, after adjusting for demographic characteristics and the presence of comorbid psychiatric conditions. Based on additional data, in part from a large managed care organization, we estimated a human capital model of the societal cost of anxiety disorders. Results We estimated the annual cost of anxiety disorders to be approximately $42.3 billion in 1990 in the United States, or $1542 per sufferer. This comprises $23.0 billion (or 54% of the total cost) in nonpsychiatric medical treatment costs, S13.3 billion (31%) in psychiatric treatment costs, $4.1 billion (10%) in indirect workplace costs, $1.2 billion (3%) in mortality costs, and $0.8 billion (2%) in prescription pharmaceutical costs. Of the $256 in workplace costs per anxious worker, 88% is attributable to lost productivity while at work as opposed to absenteeism. Posttraumatic stress disorder and panic disorder are the anxiety disorders found to have the highest rates of service use. Other than simple phobia, all anxiety disorders analyzed are associated with impairment in workplace performance. Conclusion Anxiety disorders impose a substantial cost on society, much of which may be avoidable with more widespread awareness, recognition, and appropriate early intervention.

The Economic Burden of Anxiety Disorders in the 1990s

Background We estimate in dollar terms the economic burden of depression in the United States on an annual basis. Method Using a human capital approach, we develop prevalence-based estimates of three major cost-of-illness categories: (1) direct costs of medical, psychiatric, and pharmacologic care; (2) mortality costs arising from depression-related suicides; and (3) morbidity costs associated with depression in the workplace. With respect to the latter category, we extend traditional cost-of-illness research to include not only the costs arising from excess absenteeism of depressed workers, but also the reductions in their productive capacity while at work during episodes of the illness. Results We estimate that the annual costs of depression in the United States total approximately $43.7 billion. Of this total, $12.4 billion-28%-is attributable to direct costs, $7.5 billion-17%-comprises mortality costs, and $23.8 billion-55%-is derived from the two morbidity cost categories. Conclusion Depression imposes significant annual costs on society. Because there are many important categories of cost that have yet to be estimated, the true burden of this illness may be even greater than is implied by our estimate. Future research on the total costs of depression may include attention to the comorbidity costs of this illness with a variety of other diseases, reductions in the quality of life experienced by sufferers, and added out-of-pocket costs resulting from the effects of this illness, including those related to household services. Finally, it may be useful to estimate the additional costs associated with expanding the definition of depression to include individuals who suffer from only some of the symptoms of this illness.

Paul E. Greenberg

Papers

Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication

The economic burden of depression in the United States: how did it change between 1990 and 2000?

The economic burden of adults with major depressive disorder in the United States (2005 and 2010).

The Economic Burden of Anxiety Disorders in the 1990s

The economic burden of depression in 1990.