Epidemiology of Depressive Disorder Maeng Je Cho, M.DJun Young Lee, M. D. Department of psychiatry Seoul National University College of Medicine & Hospital Email : mjcho@plaza.snu.ac.krbenji@naver.com Abstract In Korea, the prevalence of major depression is 4 per 100 and the world prevalence is 10 per 100. Risk factors are women, younger cohort, separated and divorced, persons with family history, early parental death and disruptive childhood environment, negative stressful events and chronic stress, absence of confidant in women, and urban areas. The mean age of onset ranges from late twenties to early thirties, but the age of onset becomes earlier and the prevalence of major depression is increasing. The recurrence rate is 85% and patients experience four episodes of depression on average and major depression is ranked as the fourth disabling disease. It was proven that major depression is one of most chronic and disabling diseases. The prognosis is poorer with comorbid dysthymia. Anxiety disorder, substance dependence, and hypothyroidism are frequent comorbid conditions with depression. And coronary arterial disease and stroke are also frequent comorbidities and their mortality rates increase with depression. The diathesisstress model of depression is supported by the genetic study of depression. In conclusion, the rate of depression is rising and depression is one of the most chronic and disabling diseases. Therefore, I hope the disease be prevented through future studies. Keywords : Major depression; Dysthymia; Keywords : Epidemiology; Prevalence; Prevention 772
(2001, WHO) Diseases % of Total Lower respiratory infections 6.4 Perinatal conditions 6.2 HIV / AIDS 6.1 Unipolar depressive disorders 4.4 Diarrheal diseases 4.2 Ischemic heart disease 3.8 Cerebrovascular disease 3.1 Road traffic accidents 2.8 Malaria 2.7 Tuberculosis 2.4 773
100 Place MD Female Male No Age Investigator Tool Diagnosis time Korea Korea USANCS USAECA Edmonton, Canada Puerto Rico Taiwan New Zealand Nijmegen, Netherlands Camberwell, UK Canberra, Australia Santander, Spain Finland 4 3.5 17.1 4.4 8.6 4.6 1.1 12.6 5.4 7.1 6.1 4.6 4.6 6.2 4.1 21.3 7 11.4 5.5 1.6 16.3 7.7 9.2 7.7 5.5 5.5 2 2.4 12.7 2.6 5.9 3.5 0.9 8.8 4.3 4.9 4.3 4.3 4.6 6242 5100 8098 18572 3258 1551 11004 1498 3245 800 756 1223 747 18~64 18~64 15~54 17~64 18~64 30+ Cho, et al.(2001) Lee, et al.(1990) Kessler, et al.(1988) Weissman, et al.(1988) Bland, et al.(1998) Canino, et al.(1987) Hwu, et al.(1996) Joyce, et al.(1990) Hodiamont, et al.(1987) Bebbington, et al.(1981) Henderson, et al.(1979) VazquezBarquero, et al. Lehtinen, et al.(1990) CIDI CIDI PSE PSE PSE PSE PSE DSMIV DSMIII DSMIIIR DSMIII DSMIII DSMIII DSMIII DSMIII ICD9 ICD9 ICD9 ICD9 ICD9 lifetime lifetime lifetime lifetime lifetime lifetime lifetime lifetime point point point point point MD : Major depressive disorder, DD : Dysthymic disorder, No : Case number, Dx : Diagnosis criteria 774
Risk factor Sex Age Socioeconomic status Marital status Family history Childhood experience Stress A confidant Residence Major depressive disorder Women Younger cohort Lower Socioeconomic status (?) Separated and divorced Persons with family history Early parental death and disruptive childhood environment Negative stressful events and chronic stress Absence of confidant in women Urban areas Adapted from Comprehensive textbook of psychiatry. 7th edition 775
776
Single episode with antecedent dysthymia % 9 Single episode without antecedent dysthymia 22 Recurrent, with antecedent dysthymia, with full interepisode recovery 4 Recurrent, with antecedent dysthymia, without full interepisode recovery 26 Recurrent, without antecedent dysthymia, with full interepisode recovery 20 Recurrent, without antecedent dysthymia, without full interepisode recovery 19 777
778
Organization, 2001 ; 19-46 12. Guze SB, Robins E. Suicide and primary affective disorders. Br J Psychiatry 1970 ; 117(539) : 437-8 13. McQuaid JR, Stein MB, Laffaye C, McCahill ME. Depression in a primary care clinic : the prevalence and impact of an un- 11. World Health Organization. Burden of mental and behavioral disorders, in World Health Report. Geneva : World Health recognized disorder. J Affect Disord 1999 ; 55(1) : 1-10 14. World Health Organization. Mental disorders : glossary and guide to their classification in accordance with the 9th revision of the International Classification of Diseases. Geneva : WHO, 1978 15. American Psychiatric Association. Diagnostic and Statistical Manual of mental disorders, 3rd ed. Washington DC : American Psychiatric Association Press, 1980 16. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Kendler KS, et al. Lifetime and 12month prevalence of DSMIIIR psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychia- try 1994 ; 51(1) : 8-19 17. Weissman MM, Leaf PJ, Tischler GL, Blazer DG, Karno M, Florio LP, et al. Affective disorders in five United States communities. Psychol Med 1988 ; 18(1) : 141-53 18. Lee CK, Kwak YS, Yamamoto J, Rhee H, Kim YS, Lee YH, et al. Psychiatric epidemiology in Korea. Part II : Urban and rural differences. J Nerv Ment Dis 1990 ; 178(4) : 247-52 19. Cho MJ. Development of the Korean version of diagnostic instruments and epidemiological studies for major psychiatric disorders. Seoul : Ministry of Health & Welfare, 2001 10. American Psychiatric Association. Diagnostic and Statistical Manual of mental disorders, 4th ed. Washington DC : American Psychiatric Association Press, 1994 11. Bland RC, Orn H, Newman SC. Lifetime prevalence of psychiatric disorders in Edmonton. Acta Psychiatr Scand Suppl 1988 ; 338 : 24-32 12. Henderson AS, Jorm AF, MacKinnon A, Christensen H, Scott LR, Doyle C, et al. The prevalence of depressive disorders and 779
the distribution of depressive symptoms in later life : a survey using Draft ICD10 and DSMIIIR. Psychol Med 1993 ; 23(3) : 719-29 13. Hodiamont P, Peer N, Syben N. Epidemiological aspects of psychiatric disorder in a Dutch health area. Psychol Med 1987 ; 17(2) : 495-505 14. Hwu HG, Yeh EK, Chang LY. Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatr Scand 1989 ; 79(2) : 136-47 15. Joyce PR, OakleyBrowne MA, Wells JE, Bushnell JA, Hornblow AR. Birth cohort trends in major depression : increasing rates and earlier onset in New Zealand. J Affect Disord 1990 ; 18(2) : 83-9 16. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Wang PS, et al. The epidemiology of major depressive disorder : results from the National Comorbidity Survey Replication (NCSR). JAMA 2003 ; 289(23) : 3095-105 17. VazquezBarquero JL, DiezManrique JF, Pena C, Quintanal RG, Labrador Lopez M. Two stage design in a community survey. Br J Psychiatry 1986 ; 149 : 88-97 18. Cassem EH. Depressive disorders in the medically ill. An overview. Psychosomatics 1995 ; 36(2) : S2-10 19. Eaton WW, Kramer M, Anthony JC, Dryman A, Shapiro S, Locke BZ. The incidence of specific /DSMIII mental disorders : data from the NIMH Epidemiologic Catchment Area Program. Acta Psychiatr Scand 1989 ; 79(2) : 163-78 20. Kelsoe J. Mood disorders : Epidemiology, in Comprehensive textbook of psychiatry, B. Sadock and V. Sadock, Editors. Philadelphia : Lippincott Williams & Wilkins, 2000 : 1298-307 21. Kendler KS, Kessler RC, Walters EE, MacLean C, Neale MC, Eaves LJ, et al. Stressful life events, genetic liability, and onset of an episode of major depression in women. Am J Psychiatry 1995 ; 152(6) : 833-42 22. Klerman GL, Weissman MM. Increasing rates of depression. JAMA 1989 ; 261(15) : 2229-35 23. The changing rate of major depression. Crossnational comparisons. CrossNational Collaborative Group. JAMA 1992 ; 268(21) : 3098-105 24. Kessler RC, Zhao S, Blazer DG, Swartz M. Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord 1997 ; 45(1-2) : 19-30 25. Weissman MM, Myers JK. Affective disorders in a US urban community : the use of research diagnostic criteria in an epidemiological survey. Arch Gen Psychiatry 1978 ; 35(11) : 1304-11 26. Bothwell S, Weissman MM. Social impairments four years after an acute depressive episode. Am J Orthopsychiatry 1977 ; 47(2) : 231-7 27. Hwu HG, Chang IH, Yeh EK, Chang CJ, and Yeh LL. Major depressive disorder in Taiwan defined by the Chinese diagnostic Interview Schedule. J Nerv Ment Dis 1996 ; 184(8) : 497-502 28. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Yeh EK, et al. Crossnational epidemiology of major depression and bipolar disorder. JAMA 1996 ; 276(4) : 293-9 29. Kleinman A. Neurasthenia and depression : a study of somatization and culture in China. Cult Med Psychiatry 1982 ; 6(2) : 117-90 30. Keller MB, Lavori PW, Mueller TI, Endicott J, Coryell W, Shea T, et al. Time to recovery, chronicity, and levels of psychopathology in major depression. A 5year prospective followup of 431 subjects. Arch Gen Psychiatry 1992 ; 49(10) : 809-16 31. Mueller TI, Leon AC, Keller MB, Solomon DA, Endicott J, Maser JD, et al. Recurrence after recovery from major depressive disorder during 15 years of observational followup. Am J Psychiatry 1999 ; 156(7) : 1000-6 32. Mueller TI, Keller MB, Leon AC, Solomon DA, Shea MT, Endicott J, et al. Recovery after 5 years of unremitting major depressive disorder. Arch Gen Psychiatry 1996 ; 53(9) : 794-9 33. Keller MB, Klein DN, Hirschfeld RM, Kocsis JH, McCullough 780
JP, Mavin DB, et al. Results of the DSMIV mood disorders field trial. Am J Psychiatry 1995 ; 152(6) : 843-9 34. Mueller TI, Leon AC. Recovery, chronicity, and levels of psychopathology in major depression. Psychiatr Clin North Am 1996 ; 19(1) : 85-102 35. Fava M, Davidson KG. Definition and epidemiology of treatmentresistant depression. Psychiatr Clin North Am 1996 ; 19(2) : 179-200 36. Petronis KR, Samuels JF, Moscicki EK, Anthony JC. An epidemiologic investigation of potential risk factors for suicide attempts. Soc Psychiatry Psychiatr Epidemiol 1990 ; 25(4) : 193-9 37. Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG. Comorbidity of DSMIIIR major depressive disorder in the general population : results from the US National Comorbidity Survey. Br J Psychiatry 1996 ; 30(Suppl) : 17-30 38. Moos RH, Mertens JR. Patterns of diagnoses, comorbidities, and treatment in latemiddleaged and older affective disorder patients : comparison of mental health and medical sectors. J Am Geriatr Soc 1996 ; 44(6) : 682-8 39. Wittchen HU, Zhao S, Kessler RC, Eaton WW. DSMIIIR generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994 ; 51(5) : 355-64 40. Horwath E, Johnson J, Weissman MM, Hornig CD. The validity of major depression with atypical features based on a community study. J Affect Disord 1992 ; 26(2) : 117-25 41. Martin CS, Arria AM, Mezzich AC, Bukstein OG. Patterns of polydrug use in adolescent alcohol abusers. Am J Drug Alcohol Abuse 1993 ; 19(4) : 511-21 42. Conte HR, Karasu TB. A review of treatment studies of minor depression : 1980-1991. Am J Psychother 1992 ; 46(1) : 58-74 43. RoyByrne PP, Stang P, Wittchen HU, Ustun B, Walters EE, Kessler RC. Lifetime panicdepression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and helpseeking. Br J Psychiatry 2000 ; 176 : 229-35 44. McDaniel JS, Musselman DL, Porter MR, Reed DA, Nemeroff CB. Depression in patients with cancer. Diagnosis, biology, and treatment. Arch Gen Psychiatry 1995 ; 52(2) : 89-99 45. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 1996 ; 93(11) : 1976-80 46. FrancoBronson K. The management of treatmentresistant depression in the medically ill. Psychiatr Clin North Am 1996 ; 19(2) : 329-50 47. Morris PL, Robinson RG, Samuels J. Depression, introversion and mortality following stroke. Aust N Z J Psychiatry 1993 ; 27(3) : 443-9 48. Scott TF, Allen D, Price TR, McConnell H, Lang D. Characterization of major depression symptoms in multiple sclerosis patients. J Neuropsychiatry Clin Neurosci 1996 ; 8(3) : 318-23 49. Kishi Y, Robinson RG, Forrester AW. Prospective longitudinal study of depression following spinal cord injury. J Neuropsychiatry Clin Neurosci 1994 ; 6(3) : 237-44 50. Blumer D, Montouris G, Hermann B. Psychiatric morbidity in seizure patients on a neurodiagnostic monitoring unit. J Neuropsychiatry Clin Neurosci 1995 ; 7(4) : 445-56 51. Sullivan PF, Neale MC, Kendler KS. Genetic epidemiology of major depression : review and metaanalysis. Am J Psychiatry 2000 ; 157(10) : 1552-62 52. von Knorring AL, Bohman M, Sigvardsson S. Early life experiences and psychiatric disorders : an adoptee study. Acta Psychiatr Scand 1982 ; 65(4) : 283-91 53. Cadoret RJ, O'Gorman TW, Heywood E, Troughton E. Genetic and environmental factors in major depression. J Affect Disord 1985 ; 9(2) : 155-64 54. Wender PH, Kety SS, Rosenthal D, Schulsinger F, Ortmann J, Lunde I. Psychiatric disorders in the biological and adoptive families of adopted individuals with affective disorders. Arch 781
Gen Psychiatry 1986 ; 43(10) : 923-9 55. Stancer HC, Weitkamp LR, Persad E, Flood C, Jorna T, Yagnow RL, et al. Confirmation of the relationship of HLA (chromosome 6) genes to depression and manic depression. II. The Ontario followup and analysis of 117 kindreds. Ann Hum Genet 1988 ; 52(Pt 4) : 279-98 56. Wilson AF, Tanna VL, Winokur G, Elston RC, Hill EM. Linkage analysis of depression spectrum disease. Biol Psychiatry 1989 ; 26(2) : 163-75 57. Oruc L, Verheyen GR, Furac I, Ivezic S, Jakovljevic M, Van Broockhoven C, et al. Positive association between the GABRA5 gene and unipolar recurrent major depression. Neuropsychobiology 1997 ; 36(2) : 62-4 58. Zubenko GS, Hughes HB, 3rd, Maher BS, Stiffler JS, Zubenko WN, Marazita ML. Genetic linkage of region containing the CREB1 gene to depressive disorders in women from families with recurrent, earlyonset, major depression. Am J Med Genet 2002 ; 114(8) : 980-7 59. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Poulton R, et al. Influence of life stress on depression : moderation by a polymorphism in the 5HTT gene. Science 2003 ; 301(5631) : 386-9 782