Findings from the largest survey ever mounted on the co-occurrence ofpsychiatric disorders among U.S. adults afford a sharper picture thanpreviously available of major depressive disorder* (MDD) in specificpopulation subgroups and of MDD's relationship to alcohol use disorders(AUDs) ** and other mental health conditions. The new analysis of datafrom the 2001-2002 National Epidemiologic Survey of Alcohol and RelatedConditions (NESARC) shows for the first time that middle age and NativeAmerican race increase the likelihood of current or lifetime MDD, alongwith female gender, low income, and separation, divorce, or widowhood.Asian, Hispanic, and black race-ethnicity reduce that risk. Conductedby the NIH's National Institute on Alcohol Abuse and Alcoholism(NIAAA), the analysis appears in the Monday, October 3, 2005 Archivesof General Psychiatry.
The NESARC involved face-to-face interviews with more than 43,000non-institutionalized individuals aged 18 years and older and questionsthat reflect diagnostic criteria established by the AmericanPsychiatric Association's Diagnostic and Statistical Manual of MentalDisorders (DSM-IV). Its principal foci were alcohol dependence(alcoholism) and alcohol abuse and the psychiatric conditions that mostfrequently co-occur with those AUDs. Because of its size and scrutinyof multiple sociodemographic factors, the NESARC provides more preciseinformation than previously available on between-group differences thatinfluence risk.
For example, the analysis indicates that 5.28 percent of U.S. adultsexperienced MDD during the 12 months preceding the survey and 13.23percent had experienced MDD at some time during their lives. Thehighest lifetime risk was among middle-aged adults, a shift from theyounger adult population shown to be at highest risk by surveysconducted during the 1980s and 1990s. "This marks an importanttransformation in the distribution of MDD in the general population andspecific risk for baby-boomers aged 45 to 64 years," note the authors.
Risk for the onset of MDD increases sharply between age 12 and age 16and more gradually up to the early 40s when it begins to decline, withmean age of onset about age 30. Women are twice as likely as men toexperience MDD and somewhat more likely to receive treatment. About 60percent of persons with MDD received treatment specifically for thedisorder, with mean treatment age at 33.5 years--a lag time of about 3years between onset and treatment. Of all persons who experienced MDD,nearly one-half wanted to die, one-third considered suicide, and 8.8percent reported a suicide attempt.
Among race-ethnic groups, Native Americans showed the highest (19.17percent) lifetime MDD prevalence, followed by whites (14.58 percent),Hispanics (9.64 percent), Blacks (8.93 percent), and Asian or PacificIslanders (8.77 percent). Since information is scarce on diagnosedmental disorders among Native Americans, this finding appears towarrant increased attention to the mental health needs of that group,the authors maintain.
Among persons with current MDD, 14.1 percent also have anAUD, 4.6 percent have a drug use disorder, and 26 percent have nicotinedependence. More than 37 percent have a personality disorder and morethan 36 percent have at least one anxiety disorder. Among persons withlifetime MDD, 40.3 percent had experienced an AUD, 17.2 percent hadexperienced a drug use disorder, and 30 percent had experiencednicotine dependence.
"Major depression is a prevalent psychiatric disorder and apressing public health problem. That it so often accompanies alcoholdependence raises questions about when and how to treat eachdiagnosis," says NIAAA Director Ting-Kai Li, M.D. "Today's results bothinform clinical practice and provide researchers with information toadvance hypotheses about common biobehavioral factors that may underlieboth conditions."
The NESARC results demonstrate a strong relationship of MDD tosubstance dependence and a weak relationship to substance abuse, afinding that suggests focusing on dependence when studying therelationship of depression to substance use disorders. This researchdirection is supported by earlier genetic studies that identifiedfactors common to MDD and alcohol dependence and at least oneepidemiologic study that demonstrated excess MDD among long-abstinentformer alcoholics, state the authors.
Coexisting substance dependence disorder and MDD predict pooroutcome among clinic patients. A decade ago, many treatment leadersdiscouraged treating MDD in patients with substance dependence on thegrounds that arresting substance dependence was the more immediate needand that its resolution well might also resolve MDD. Results fromforegoing epidemiologic surveys and several clinical trials over timealtered that picture, so that treating both disorders simultaneously istoday common practice.
The NESARC also found strong relationships between MDD and anxietydisorders, with the strongest comorbidity for current diagnoses. Inaddition, MDD was strongly associated with personality disorders, butthe magnitude of the association varied considerably among discretepersonality disorder types. "Given the seriousness of MDD, theimportance of information on its prevalence, demographic correlates,and psychiatric comorbidity cannot be overstated," note the authors."This study provides the grounds for further investigation in a numberof areas."
The Epidemiology of Major Depressive Disorder by principal investigatorBridget F. Grant, Ph.D., Chief, Laboratory of Epidemiology andBiometry, NIAAA, in collaboration with Deborah S. Hasin, Ph.D., ofColumbia University and New York State Psychiatric Institute and theircoauthors is available online to journalists at www.jamamedia.org. Forinterviews with Dr. Grant, please contact the NIAAA Press Office.
The NESARC data set, interview, descriptive materials, and citations are available at http://niaaa.census.gov/. News releases based on NESARC data and additional alcohol research information and publications are available at www.niaaa.nih.gov.
*The NESARC defined lifetime MDD as having had at least onemajor depressive episode (at least 2 weeks of persistent depressed moodaccompanied by at least five symptoms of DSM-IV major depressionwithout history of a bipolar disorder) over the life course. CurrentMDD was defined as having had at least one major depressive episodeduring the 12 months preceding the survey among persons classified withlifetime MDD.
** The AUDs alcohol dependence and alcohol abuse (togetherwith nicotine and illicit drug use disorders) comprise DSM-IV substanceuse disorders. Alcohol dependence, also known as alcoholism, ischaracterized by impaired control over drinking, compulsive drinking,preoccupation with drinking, withdrawal symptoms, and/or tolerance toalcohol. Alcohol abuse is characterized by recurrent drinking resultingin failure to fulfill major role obligations at work, school, or home;persistent or recurrent alcohol-related interpersonal, social, or legalproblems; and/or recurrent drinking in hazardous situations.
The National Institute on Alcohol Abuse and Alcoholism, acomponent of the National Institutes of Health, U.S. Department ofHealth and Human Services, conducts and supports approximately 90percent of U.S. research on the causes, consequences, prevention, andtreatment of alcohol abuse, alcoholism, and alcohol problems anddisseminates research findings to science, practitioner, policy makingand general audiences.
Materials provided by NIH/National Institute on Alcohol Abuse and Alcoholism. Note: Content may be edited for style and length.
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