Customize your JAMA Network experience by selecting one or more topics from the list below.
Kessler RC, Berglund P, Demler O, et al. The Epidemiology of Major Depressive Disorder: Results From the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–3105. doi:10.1001/jama.289.23.3095
Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler and Wang, Mss Demler and Walters, and Mr Jin); Institute for Social Research, University of Michigan, Ann Arbor (Ms Berglund); Division of Mental Disorders, Behavioral Research and AIDS (Dr Koretz), and Intramural Research Program (Dr Merikangas), National Institute of Mental Health, Rockville, Md; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Dr Rush); Brigham and Womens' Hospital, Harvard Medical School (Dr Wang).
Context Uncertainties exist about prevalence and correlates of major depressive
Objective 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).
Design Face-to-face household survey conducted from February 2001 to December
Setting The 48 contiguous United States.
Participants Household residents ages 18 years or older (N = 9090) who responded
to the NCS-R survey.
Main Outcome Measures 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.
Results 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.
Conclusions 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.
Create a personal account or sign in to: