Cross-national epidemiology of DSM-IV major depressive episode

Background: Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low-to middle-income countries in the World Mental Health Survey Initiative. Methods: Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults. Results: The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2: 1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low-to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed. Conclusions: MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.

(NIH/NIMH) United States National Institute of Mental Health[R01MH070884]

John D. and Catherine T. MacArthur Foundation

Pfizer Foundation

USA Public Health Service[R13-MH066849]

USA Public Health Service[R01-MH069864]

USA Public Health Service[R01 DA016558]

(NIH) Fogarty International Center[FIRCA R03-TW006481]

PAHO Pan American Health Organization

Eli Lilly & Company Foundation

Ortho-McNeil Pharmaceutical, Inc.

GlaxoSmithKline

Sanofi-Aventis

Bristol-Myers Squibb

State of Brazil Research Foundation (FAPESP)[03/00204-3]

Ministry of Social Protection

European Commission[QLG5-1999-01042]

European Commission[SANCO 2004123]

Piedmont Region (Italy)

Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain[FIS 00/0028]

Spanish Ministerio de Ciencia y Tecnologia[SAF 2000-158-CE]

Departament de Salut, Generalitat de Catalunya, Spain

Instituto de Salud Carlos III[CIBER CB06/02/0046]

Instituto de Salud Carlos III[RETICS RD06/0011 REM-TAP]

Government of India

WHO

Ministry of Health

Israel National Institute for Health Policy and Health Services Research

National Insurance Institute of Israel

Japan Ministry of Health, Labour and Welfare[H13-Shogai-023]

Japan Ministry of Health, Labour and Welfare[H14-Tokubetsu-026]

Japan Ministry of Health, Labour and Welfare[H16-Kokoro-013]

Lebanese Ministry of Public Health

WHO (Lebanon)

(NIH) Fogarty International, anonymous private donations to IDRAAC, Lebanon

Janssen Cilag

Eli Lilly

Roche

Novartis

National Institute of Psychiatry Ramon de la Fuente[INPRFMDIES 4280]

CNPq National Council on Science and Technology[CONACyT-G30544-H]

PanAmerican Health Organization (PAHO)

New Zealand Ministry of Health, Alcohol Advisory Council

Health Research Council

(NIH/NIMH) USA National Institute of Mental Health[R01-MH059575]

(NIH/NIMH) USA National Institute of Mental Health[RO1-MH61905]

National Institute of Drug Abuse

South African Department of Health

University of Michigan

National Institute of Mental Health (NIH/NIMH)[U01-MH60220]

National Institute of Drug Abuse (NIDA)

Substance Abuse and Mental Health Services Administration (SAMHSA)

Robert Wood Johnson Foundation (RWJF)[044708]

John W. Alden Trusts

Analysis Group Inc.

Eli Lilly Company

EPI-Q

Johnson & Johnson Pharmaceuticals

Ortho-McNeil Janssen Scientific Affairs

Pfizer Inc.

Shire USA, Inc.