The DSM-5 major depressive disorder (MDD) diagnosis is highly prevalent in US adults, according to study findings published in JAMA Psychiatry.
Investigators assessed a series of in-person interviews with 36,309 adult participants who took part in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III to determine the nationwide prevalence of DSM-5 MDD. A diagnosis of a major depressive episode was made when an individual had a self-reported or observable ≥2-week incidence of anhedonia, depressed mood, or feeling of hopelessness and met five of the 9 DSM-5 MDD criteria. In addition, lifetime DSM-5 MDD was characterized as ≥1 lifetime MDD episode without full DSM-5 hypomanic, manic, or mixed episodes.
The lifetime prevalence of MDD was 20.6% in the entire study population, whereas the 12-month prevalence of MDD was 10.4%. Men (odds ratio [OR] 0.5; 95% CI, 0.46-0.55), African American (OR 0.6; 95% CI, 0.54-0.68), Asian/Pacific Islander (OR 0.6; 95% CI, 0.45-0.67), and Hispanic (OR 0.7; 95% CI, 0.62-0.78) adults had significantly lower odds of 12-month MDD. Conversely, younger adults (age range, 18 to 29; OR 3.0; 95% CI, 2.48-3.55) and individuals with low incomes ($19,999 or less; OR 1.7; 95% CI, 1.49-2.04) had a higher 12-month prevalence of the disorder.
Approximately half of lifetime cases of MDD were considered severe (49.5%) and 39.7% were moderate in nature. In patients with lifetime MDD, 12.9% of participates primarily occurred after the death of a loved one, and these episodes generally lasted <2 months. The anxious/distressed specifier defined up to 74.6% of cases of MDD. The mixed-features specifier, which consisted of ≥3 features (eg, elevated or expansive mood, inflated self-esteem or grandiosity, unusual talkativeness or pressure to keep talking, flight of ideas or racing thoughts, increased energy or goal-directed activity, involvement in activities with the potential for painful consequences, and decreased sleep requirement), occurred in 15.5% of participants. Both the anxious/distressed and the mixed-features specifiers correlated with early onset, suicidality, and poor course and functioning when the analysis was adjusted for MDD severity.
Considering that this was a cross-sectional study of interview data, the findings do not report causal relationships in patients with MDD. In addition, due to the interview design, this study was prone to recall bias.
There remains a substantial need to reduce the high MDD prevalence “given the personal, public health, and economic burdens that the disorder imposes.”
Hasin DS, Sarvet AL, Meyers JL, et al. Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States [published online February 14, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4602