The Epidemiology of Chronic Major Depressive Disorder and Dysthymic Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Department of Psychiatry, College of Physicians and Surgeons New York State Psychiatric Institute, New York, New York, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.81). 12/2010; 71(12):1645-56. DOI: 10.4088/JCP.09m05663gry
Source: PubMed

ABSTRACT To examine the prevalence of chronic major depressive disorder (CMDD) and dysthymic disorder, their sociodemographic correlates, patterns of 12-month and lifetime psychiatric comorbidity, lifetime risk factors, psychosocial functioning, and mental health service utilization.
Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093).
The 12-month and lifetime prevalences were greater for CMDD (1.5% and 3.1%, respectively) than for dysthymic disorder (0.5% and 0.9%, respectively). Individuals with CMDD and dysthymic disorder shared most sociodemographic correlates and lifetime risk factors for major depressive disorder. Individuals with CMDD and dysthymic disorder had almost identically high rates of Axis I and Axis II comorbid disorders. However, individuals with CMDD received higher rates of all treatment modalities than individuals with dysthymic disorder.
Individuals with CMDD and dysthymic disorder share many sociodemographic correlates, comorbidity patterns, risk factors, and course. Individuals with chronic depressive disorders, especially those with dysthymic disorder, continue to face substantial unmet treatment needs.

1 Bookmark
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Approximately 20–30% of patients with Major depressive disorder (MDD) develop a chronic course of their disease. Chronic depression is associated with increased health care utilisation, hospitalisation and a higher disease burden. We identified clinical correlates and differences in treatment response of chronic MDD (cMDD) patients compared with non-chronic episodic depression in a huge sample of depressive inpatients.Methods Data were collected from 412 inpatients who had been diagnosed with a major depressive episode (MDE; according to ICD-10) and scored 15 or higher on the 21-item Hamilton Depression Rating Scale (HRSD-21). All subjects were participants in the German Algorithm Project, phase 3 (GAP3). Patients who were diagnosed with a MDE within the last two years or longer (herein referred to as CD) were compared with non-chronic depressive patients (herein referred to as non-CD). CD and non-CD patients were assessed for the following: psychosocial characteristics, symptom reduction from hospital admission to discharge, symptom severity at discharge, remission and response rates, and pharmacological treatment during inpatient treatment. The primary outcome measure was the HRSD-21.Results13.6% (n=56) of patients met the criteria for chronic depression. Compared with non-CD patients, patients with CD showed increased axis I comorbidities (74% vs. 52%, χ2 (1)=7.31, p=.02), a higher level of depressive symptoms at baseline and discharge, increased duration of inpatient treatment (64.8 vs. 53.3 days; t=2.86, p=.03) and lower response (HRSD: 60.0% vs. 72.0%; χ2 (1)=3.61, p<.04; BDI: 40.5% vs. 54.2%; χ2 (1)=3.56, p=.04) and remission rates (BDI 17.9.% vs. 29.7%; χ2 (1)=3.42, p=.05. However, both groups achieved a comparable symptom reduction during inpatient treatment. The prescribed pharmacological strategy had no significant influence on treatment outcome in patients with CD.Conclusion Inpatients with CD show higher symptom severity, lower response and remission rates and a longer duration of inpatient treatment, although they achieve comparable symptom reduction during treatment. These findings support the need to recognise CD and its defining characteristics as a distinct subclass of depression.
    Journal of Affective Disorders 11/2014; DOI:10.1016/j.jad.2014.10.059 · 3.71 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Up-to-date epidemiological data on depressive disorders is needed to understand changes in population health and health care utilization. This study aims to assess the prevalence of major depressive disorder (MDD) and dysthymia in the Finnish population and possible changes during the past 11 years. In a nationally representative sample of Finns aged 30 and above (BRIF8901), depressive disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000 and 2011. To account for nonresponse, two methods were compared: multiple imputation (MI) utilizing data from the hospital discharge register and from the interview in 2000 and statistical weighting. The MI-corrected 12-month prevalence of MDD was 7.4% (95% CI 5.7-9.0) and of dysthymia was 4.5% (95% CI 3.1-5.9), whereas the corresponding figures using weights were 5.4% (95% CI 4.7-6.1) for MDD and 2.0% (95% CI 1.6-2.4) for dysthymia. Women (OR 2.33, 95% CI 1.6-3.4) and unmarried people (OR 1.54, 95% CI 1.2-2.0) had a higher risk of depressive disorders. There was a significant increase in the prevalence of depressive disorders during the follow-up period from 7.3% in 2000 to 9.6% in 2011. Prevalences were two percentage points higher, on average, when using MI compared to weighting. Hospital treatments for depressive disorders and other mental disorders were strongly associated with nonparticipation. The CIDI response rate dropped from 75% in 2000 to 57% in 2011, but this was accounted for by MI and weighting. Depressive disorders are a growing public health concern in Finland. Non-participation of persons with severe mental disorders may bias the prevalence estimates of mental disorders in population-based studies. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 11/2014; 173C:73-80. DOI:10.1016/j.jad.2014.10.015 · 3.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Problematic alcohol consumption is associated with multiple medical conditions and psychiatric comorbidities. Previous publications reported the under-recognition of alcohol-related problems in the clinical setting. The present study comprises of two objectives, 1) to examine the process use by physicians to recognize alcohol-related problems in psychiatric outpatient units, and 2) to compare the results of a CAGE interview and a written version of the CAGE questionnaire.

Full-text (2 Sources)

Available from
May 30, 2014