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May 1986

Treatment for Depression: 'Standard' Clinical Practice as an Unexamined Topic

Author Affiliations

From the Department of Psychiatry, University of Pittsburgh School of Medicine (Dr Kupfer); and the Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California, Los Angeles (Dr Freedman).

Arch Gen Psychiatry. 1986;43(5):509-511. doi:10.1001/archpsyc.1986.01800050115015

The first reports from the epidemiologic catchment area (ECA) studies, in line with other recent, smaller surveys, indicated a lifetime prevalence for affective disorders between 6.1% and 9% and a six-month prevalence of affective disorders ranging from 4.6% to 6.5%.1,2 Yet despite the prevalence of the disorder and increasing recognition of it by a more informed public, two recent sources of evidence point to the underuse of treatment. The ECA studies and the recent Consensus Development Conference on Recurrent Mood Disorders3 both concluded that less than one third of those individuals suffering from a depressive illness actually receive treatment. The early ECA findings suggest that only 31.2% to 31.7% of subjects meeting criteria for an affective disorder are likely to obtain professional care.4 While there are complexities in determining what constitutes a "case"5 or appropriate diagnosis and treatment, the extent and actual basis of underdiagnosis or

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