|National Survey Sharpens Picture of Major Depression Among
Findings from the largest survey ever mounted on the co-occurrence of psychiatric
disorders among U.S. adults afford a sharper picture than previously available
of major depressive disorder* (MDD) in specific population subgroups and of MDD’s
relationship to alcohol use disorders (AUDs)** and other mental health conditions.
The new analysis of data from the 2001-2002 National Epidemiologic Survey of
Alcohol and Related Conditions (NESARC) shows for the first time that middle
age and Native American race increase the likelihood of current or lifetime MDD,
along with female gender, low income, and separation, divorce, or widowhood.
Asian, Hispanic, and black race-ethnicity reduce that risk. Conducted by the
NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA), the analysis
appears in the Monday, October 3, 2005 Archives of General Psychiatry.
The NESARC involved face-to-face interviews with more than 43,000 non-institutionalized
individuals aged 18 years and older and questions that reflect diagnostic criteria
established by the American Psychiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV). Its principal foci were alcohol dependence
(alcoholism) and alcohol abuse and the psychiatric conditions that most frequently
co-occur with those AUDs. Because of its size and scrutiny of multiple sociodemographic
factors, the NESARC provides more precise information than previously available
on between-group differences that influence risk.
For example, the analysis indicates that 5.28 percent of U.S. adults experienced
MDD during the 12 months preceding the survey and 13.23 percent had experienced
MDD at some time during their lives. The highest lifetime risk was among middle-aged
adults, a shift from the younger adult population shown to be at highest risk
by surveys conducted during the 1980s and 1990s. “This marks an important transformation
in the distribution of MDD in the general population and specific 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 16 and more
gradually up to the early 40s when it begins to decline, with mean age of onset
about age 30. Women are twice as likely as men to experience MDD and somewhat
more likely to receive treatment. About 60 percent of persons with MDD received
treatment specifically for the disorder, with mean treatment age at 33.5 years — a
lag time of about 3 years between onset and treatment. Of all persons who experienced
MDD, nearly one-half wanted to die, one-third considered suicide, and 8.8 percent
reported a suicide attempt.
Among race-ethnic groups, Native Americans showed the highest (19.17 percent)
lifetime MDD prevalence, followed by whites (14.58 percent), Hispanics (9.64
percent), Blacks (8.93 percent), and Asian or Pacific Islanders (8.77 percent).
Since information is scarce on diagnosed mental disorders among Native Americans,
this finding appears to warrant increased attention to the mental health needs
of that group, the authors maintain.
Among persons with current MDD, 14.1 percent also have an AUD, 4.6 percent have
a drug use disorder, and 26 percent have nicotine dependence. More than 37 percent
have a personality disorder and more than 36 percent have at least one anxiety
disorder. Among persons with lifetime MDD, 40.3 percent had experienced an AUD,
17.2 percent had experienced a drug use disorder, and 30 percent had experienced
"Major depression is a prevalent psychiatric disorder and a pressing public
health problem. That it so often accompanies alcohol dependence raises questions
about when and how to treat each diagnosis,” says NIAAA Director Ting-Kai Li,
M.D. “Today’s results both inform clinical practice and provide researchers with
information to advance hypotheses about common biobehavioral factors that may
underlie both conditions.”
The NESARC results demonstrate a strong relationship of MDD to substance dependence
and a weak relationship to substance abuse, a finding that suggests focusing
on dependence when studying the relationship of depression to substance use disorders.
This research direction is supported by earlier genetic studies that identified
factors common to MDD and alcohol dependence and at least one epidemiologic study
that demonstrated excess MDD among long-abstinent former alcoholics, state the
Coexisting substance dependence disorder and MDD predict poor outcome among
clinic patients. A decade ago, many treatment leaders discouraged treating MDD
in patients with substance dependence on the grounds that arresting substance
dependence was the more immediate need and that its resolution well might also
resolve MDD. Results from foregoing epidemiologic surveys and several clinical
trials over time altered that picture, so that treating both disorders simultaneously
is today common practice.
The NESARC also found strong relationships between MDD and anxiety disorders,
with the strongest comorbidity for current diagnoses. In addition, MDD was strongly
associated with personality disorders, but the magnitude of the association varied
considerably among discrete personality disorder types. “Given the seriousness
of MDD, the importance 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 number of areas.”
The Epidemiology of Major Depressive Disorder by principal investigator Bridget
F. Grant, Ph.D., Chief, Laboratory of Epidemiology and Biometry, NIAAA, in collaboration
with Deborah S. Hasin, Ph.D., of Columbia University and New York State Psychiatric
Institute and their coauthors is available online to journalists at www.jamamedia.org.
For interviews 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 National Institute on Alcohol Abuse and Alcoholism, a component of the National
Institutes of Health, U.S. Department of Health and Human Services, conducts and
supports approximately 90 percent of U.S. research on the causes, consequences,
prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems and
disseminates research findings to science, practitioner, policy making and general
The National Institutes of Health (NIH) — The Nation's Medical Research
Agency — includes 27 Institutes and Centers and is a component of
the U. S. Department of Health and Human Services. It is the primary Federal
agency for conducting and supporting basic, clinical, and translational medical
research, and it investigates the causes, treatments, and cures for both common
and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.