Depression

Prevalence and Impact of Depressive Disorders

The lifetime risk of MDD is between 10% and 25% for women and 5% and 12 % for men. There is some [Page 558]evidence that the incidence of depression and suicidal behavior is increasing across generations. For example, depression is now believed to be more frequent in adolescence than in adulthood. Within primary care medical settings, depression is possibly the most commonly experienced psychiatric problem. From 10% to 29% of patients in these settings have a depressive disorder and psychologists believe that clinical depression is largely unrecognized in this context.

Episodes of major depression are associated with extensive disruptions of normal functioning. These disruptions include exacerbation of medical illness and impaired physical health; diminished ability to concentrate, reason, and problem solve; decreased participation in pleasurable and rewarding activities; and problems with interpersonal relationships. The experience of a major depressive episode greatly increases the likelihood that future depressive episodes will occur. Major depression also increases vulnerability to other psychiatric problems such as anxiety disorders and alcohol abuse. The direct cost (e.g., health care and medication) of treating clinical depression is about $400 million to $500 million annually.

Risk Factors

A variety of factors account for the greater incidence of depression observed among women relative to men. Women face different Stressors (e.g., physical and sexual abuse) than men and have greater stress reactivity. They also differ in their cognitive coping styles and self-report strategies. Biological factors including increased responsiveness to hormonal changes such as those associated with the menstrual cycle and postpartum period also play a role.

Other risk factors include Caucasian ethnicity, marital separation or divorce, prior depressive episodes, poor physical health or medical illnesses, low socioeconomic status, unemployment, loss of a loved one, and family history of depression. Although major depression may develop at any age, the average age of onset is 15 to 19 years in females and 25 to 29 years for males. The average age of onset has been decreasing steadily over the past 3 decades. The elderly do not appear more susceptible to depression.

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