Despite
the high prevalence of depression, treatment,
when given, is frequently inadequate
A
recent replication of the National Comorbidity
Survey (NCS-R) has provided updated information
on the prevalence of major depressive disorder
(MDD) and treatment in the USA.
The 9090 participants who responded to the NCS-R
survey were adults aged 18 years or older. The
World Health Organization's (WHO) Composite
International Diagnostic Interview (CIDI),
12-month severity with the Quick Inventory of
Depressive Symptomatology Self-Report (QIDS-SR),
the Sheehan Disability Scale (SDS), and the WHO
disability assessment scale (WHO-DAS) were used
to diagnose depression and measure its
prevalence and correlates.
The survey showed that 16.2% of people
questioned had experienced an episode of MDD
during their lifetime and 6.6% during the 12
months preceeding the survey. In this latter
group, 10.4% had a mild episode, 38.6% moderate,
38.0% severe, and 12.9% very severe. Episodes
lasted about 16 weeks and 59.3% caused severe or
very severe role impairment, inability to work
or carry on normal activities. A large majority,
72.1% of lifetime and 78.5% of previous12-month
cases had comorbid mental disorders. Among the
12-month patients, 51.6% took medication for
MDD, although treatment was considered
"adequate" in less than half of these (41.9%).
Therefore overall only 21.7% of people with
recent depression had received "adequate"
treatment.
These data show that depression is a common and
disruptive condition. It is better
diagnosed and more frequently treated now than a
few years ago. These positive elements must not
hide the fact that treatment is still often
inadequate and that much remains to be done to
improve the management of depression. JAMA
289: 3095-3105, 2003