Dr Anthony raises some important issues concerning the birthcohort trends. Before concluding that some form of temporal effect is operating to increase rates of depression, he says it is necessary to rule out possible artifacts, particularly those caused by the methods of ascertainment and/or diagnostic assessment.He is correct in stating that the SADS-RDC criteria require helpseeking and/or a report of impaired functioning. It is possible that more recently born cohorts, because of education and cultural attitudes, are more likely to define their symptoms as being worthy of professional attention than are cohorts born earlier in the 20th century.The SADS-RDC criteria for major depressive disorder, like the DSM-III criteria for major depression, have also been criticized for being too broad and including in the diagnosis of patients with depression who have reactive episodes or who have elements of personality disorder or demoralization. For this reason, some investigators have
Klerman GL. A Potential Artifact in Determining Rates of Depression-Reply. Arch Gen Psychiatry. 1987;44(8):759–760. doi:10.1001/archpsyc.1987.01800200087014
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